Document Type : Review


Shahid Beheshti University of Medical sciences, Faculty of medicine, Tehran, Iran



Bone mineral densitometry (BMD) is the most valuable method for assessing bone and calculating fracture risk. Serial or comparative bone densitometry is important in rheumatologists' work on osteoporosis management. The response or lack of response to osteoporosis treatment based on densitometry scans is crucial. This paper examines the timing of scan requests concerning the history of glucocorticoid use, renal or other solid organ transplantation, malignancy, and other situations discussed. We encountered four types of compared scans based on the centers where BMD was performed and the precision of the devices used for this survey: Same Center, Same Device (SSSD), Same Center Different Devices (SCDD), Different Centers Same Devices (DCSD), and Different Centers Different Devices (DCDD). We discussed the principles of comparison and the key indicators.


Main Subjects

  1. Lenchik L, Kiebzak GM, Blunt BA. What is the role of serial bone mineral density measurements in patient management? J Clin Densitom 2002; 5 Suppl:S29-38. doi: 10.1385/jcd:5:3s:s29.
  2. Kendler DL, Compston J, Carey JJ, Wu CH, Ibrahim A, Lewiecki EM. Repeating Measurement of Bone Mineral Density when Monitoring with Dual-energy X-ray Absorptiometry: 2019 ISCD Official Position. J Clin Densitom 2019; 22(4):489-500. doi: 10.1016/j.jocd.2019.07.010.
  3. Hillier TA, Stone KL, Bauer DC, Rizzo JH, Pedula KL, Cauley JA. et al. Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Arch Intern Med 2007; 167(2):155-60. doi: 10.1001/archinte.167.2.155.
  4. Chotiyarnwong P, McCloskey EV. Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment. Nat Rev Endocrinol 2020; 16(8):437-47. doi: 10.1038/s41574-020-0341-0.
  5. Unal A, Kocyigit I, Sipahioglu MH, Tokgoz B, Kavuncuoglu F, Oymak O. et al. Loss of bone mineral density in renal transplantation recipients. Transplant Proc 2010; 42(9):3550-3. doi: 10.1016/j.transproceed.2010.07.106.
  6. Batteux B, Gras-Champel V, Lando M, Brazier F, Mentaverri R, Desailly-Henry I. et al. Early steroid withdrawal has a positive effect on bone in kidney transplant recipients: a propensity score study with inverse probability-of-treatment weighting. Ther Adv Musculoskelet Dis 2020; 12:1759720x20953357. doi: 10.1177/1759720x20953357.
  7. Hadji P, Aapro MS, Body JJ, Gnant M, Brandi ML, Reginster JY. et al. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol 2017; 7:1-12. doi: 10.1016/j.jbo.2017.03.001.
  8. Pazianas M, Miller PD. Osteoporosis and Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD): Back to Basics. Am J Kidney Dis 2021; 78(4):582-89. doi: 10.1053/j.ajkd.2020.12.024.
  9. Official website of the International Society for ClinicalDensitometry (ISCD),, last reviewed on1/31/2021.
  10. Bone density.[]
  11. Abdellah El M. Interpreting a DXA Scan in Clinical Practice. In: Dual Energy X-Ray Absorptiometry. Edited by Abdellah El M. IntechOpen, Rijeka; 2012: Ch. 1.
  12. L. Bonnick and L.A. Lewis, Performing a DXA PA Lumbar Spine, Proximal Femur, or Forearm DXA Study, In: Bone Densitometry for Technologists, 3rd edition, 2013, P: 97-118.
  13. Lekamwasam S, Lenora RS. Effect of leg rotation on hip bone mineral density measurements. J Clin Densitom 2003; 6(4):331-6. doi: 10.1385/jcd:6:4:331.
  14. Faulkner KG, Genant HK, McClung M. Bilateral comparison of femoral bone density and hip axis length from single and fan beam DXA scans. Calcif Tissue Int 1995; 56(1):26-31. doi: 10.1007/bf00298740.
  15. Wong JC, Ong B. Evaluation of femur angle abduction/adduction and bone mineral density values. J Clin Densitom 2005; 8(4):472-5.
  16. Licata AA, Williams SE. A DXA Primer for the Practicing Clinician: A Case-Based Manual for Understanding and Interpreting Bone Densitometry, 1 edn New York, NY; 2014.
  17. Morgan SL, Lopez-Ben R, Nunnally N, Burroughs L, Fineberg N, Tubbs RS. et al. The effect of common artifacts lateral to the spine on bone mineral density in the lumbar spine. J Clin Densitom 2008; 11(2):243-9. doi: 10.1016/j.jocd.2007.11.004.
  18. Wahner H. Technical aspects and clinical interpretation of bone mineral measurements. Public Health Rep 1989; 104 Suppl(Suppl):27-30.
  19. Lentle BC, Prior JC. Osteoporosis: What a clinician expects to learn from a patient's bone density examination. Radiology 2003; 228(3):620-8. doi: 10.1148/radiol.2283020093.
  20. Jacobson JA, Jamadar DA, Hayes CW. Dual X-ray absorptiometry: recognizing image artifacts and pathology. AJR Am J Roentgenol 2000; 174(6):1699-705. doi: 10.2214/ajr.174.6.1741699.
  21. Antonacci MD, Hanson DS, Leblanc A, Heggeness MH. Regional variation in vertebral bone density and trabecular architecture are influenced by osteoarthritic change and osteoporosis. Spine (Phila Pa 1976) 1997; 22(20):2393-401; discussion 401-2. doi: 10.1097/00007632-199710150-00014.
  22. Briggs AM, Wark JD, Greig AM, Fazzalari NL, KantorS, Bennell KL. Subregional bone mineral densitymeasurement in the lumbar spine using DXA: Potentialfor the application to osteoporosis and vertebralfractures. In: Mattingly BE, Pillare AC, (eds)Osteoporosis: Etiology, Diagnosis and Treatment. NovaPublishers, New York, 2009; 1-50.
  23. Cvijanovic O, Bobinac D, Zoricic S, Ostojic Z, Maric I, Crncevic-Orlic Z. et al. Age- and region-dependent changes in human lumbar vertebral bone: a histomorphometric study. Spine (Phila Pa 1976) 2004; 29(21):2370-5. doi: 10.1097/01.brs.0000143620.95267.39.
  24. Keller TS, Moeljanto E, Main JA, Spengler DM. Distribution and orientation of bone in the human lumbar vertebral centrum. J Spinal Disord 1992; 5(1):60-74. doi: 10.1097/00002517-199203000-00008.
  25. Nepper-Rasmussen J, Mosekilde L. Local differences in mineral content in vertebral trabecular bone measured by dual-energy computed tomography. Acta Radiol 1989; 30(4):369-71.
  26. Oda K, Shibayama Y, Abe M, Onomura T. Morphogenesis of vertebral deformities in involutional osteoporosis. Age-related, three-dimensional trabecular structure. Spine (Phila Pa 1976) 1998; 23(9):1050-5, discussion 56. doi: 10.1097/00007632-199805010-00016.
  27. Kim DG, Hunt CA, Zauel R, Fyhrie DP, Yeni YN. The effect of regional variations of the trabecular bone properties on the compressive strength of human vertebral bodies. Ann Biomed Eng 2007; 35(11):1907-13. doi: 10.1007/s10439-007-9363-1.
  28. Briggs AM, Wark JD, Kantor S, Teh R, Greig AM, Fazzalari NL. et al. In vivo intrarater and interrater precision of measuring apparent bone mineral density in vertebral subregions using supine lateral dual-energy x-ray absorptiometry. J Clin Densitom 2005; 8(3):314-9. doi: 10.1385/jcd:8:3:314.
  29. Sran MM, Khan KM, Keiver K, Chew JB, McKay HA, Oxland TR. Accuracy of DXA scanning of the thoracic spine: cadaveric studies comparing BMC, areal BMD and geometric estimates of volumetric BMD against ash weight and CT measures of bone volume. Eur Spine J 2005; 14(10):971-6. doi: 10.1007/s00586-004-0836-8.
  30. Homminga J, Weinans H, Gowin W, Felsenberg D, Huiskes R. Osteoporosis changes the amount of vertebral trabecular bone at risk of fracture but not the vertebral load distribution. Spine (Phila Pa 1976) 2001; 26(14):1555-61. doi: 10.1097/00007632-200107150-00010.
  31. Meng X-l, Rosenthal R, Rubin DB. Comparing correlated correlation coefficients. Psychological Bulletin 1992; 111(1):172-75. doi: 10.1037/0033-2909.111.1.172.
  32. Sornay-Rendu E, Boutroy S, Munoz F, Delmas PD. Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res 2007; 22(3):425-33. doi: 10.1359/jbmr.061206.
  33. Porter JL, Varacallo M. Osteoporosis. In: StatPearls PublishingCopyright © 2023, StatPearls Publishing LLC., Treasure Island (FL) ineligible companies. Disclosure: Matthew Varacallo declares no relevant financial relationships with ineligible companies.; 2023.
  34. Utilization of DXA Bone Mineral Densitometry in Ontario: An Evidence-Based Analysis. Ont Health Technol Assess Ser 2006; 6(20):1-180.
  35. Bartl R. Monitoring of Patients on Treatment. In: Osteoporosis in Clinical Practice. Edited by Bartl R. Springer International Publishing, Cham; 2023: 121-25.
  36. Lewiecki EM. Osteoporosis Treatment Success and Failure. In: Osteoporosis: A Clinical Casebook. Edited by Cusano NE. Springer International Publishing, Cham; 2021: 185-95.