A Beginner’s Guide to X-ray Absorptiometry

X-ray absorptiometry, specifically Dual-Energy X-ray Absorptiometry (DXA or DEXA), is a crucial technique used for measuring bone mineral density (BMD) and body composition. Scientific experts in various fields can benefit from understanding the intricacies of this technique, especially regarding metabolic bone disorders, osteoporosis, fracture risk assessment, and body composition evaluation. Therefore, in this comprehensive guide, we will look at the principles, applications, and limitations of DXA. 

What is X-ray Absorptiometry?

X-ray absorptiometry involves the use of two X-ray beams with different energy levels directed at the patient’s bones. By measuring the absorption of each beam and subtracting the absorption of soft tissue, DXA accurately determines bone mineral density. DXA distinguishes between three compartments based on their specific X-ray attenuation properties: bone mineral content, fat mass, and lean mass.1

Understanding the principles and functions of DXA is essential for medical professionals to make informed decisions when utilizing this technique in clinical practice, especially as DXA has a wide range of applications. We explore those applications in more detail in the following section.

Applications of X-ray Absorptiometry

As we’ve already mentioned, DXA has various applications in science, so let’s explore them in more detail.

Assessing Fracture Risk

One of the primary applications of DXA is assessing fracture risk in individuals, especially in postmenopausal women and older adults. DXA measurements help predict the risk of future fractures by quantifying bone mineral density and providing valuable information for fracture prevention strategies.

Body Composition Assessment

DXA is not only limited to measuring bone mineral density, as it also provides insights into body composition. It accurately quantifies fat mass and lean mass, which is required when evaluating conditions related to body composition abnormalities, such as sarcopenia and obesity. DXA’s ability to differentiate between different tissue types contributes to a comprehensive assessment of overall body composition.

Diagnosis of Osteoporosis

DXA is considered the gold standard for diagnosing osteoporosis. It provides precise measurements of bone mineral density, particularly in the lumbar spine, femoral neck, and total hip. The results obtained from DXA scans enable healthcare professionals to assess bone health and evaluate the need for preventive measures or treatment interventions.

Evaluation of Metabolic Bone Disorders

DXA plays a critical role in evaluating metabolic bone disorders such as osteoporosis, osteomalacia, and osteogenesis imperfecta. By measuring bone mineral density, DXA aids in the diagnosis, monitoring, and treatment of these conditions. It helps identify individuals at risk of fractures and guides therapeutic interventions to prevent bone loss.

Advantages of X-ray Absorptiometry

DXA offers numerous advantages when compared to other imaging techniques. One notable advantage is its significantly lower radiation dose, ensuring a safer experience for patients. Other advantages of DXA include the following: 

Accuracy and Simplicity of Use

DXA provides highly accurate and reproducible results, making it efficient for assessing bone mineral density and body composition. The simplicity of the procedure allows for widespread use in clinical settings, aiding in the diagnosis and management of various medical conditions.

Effective in Identifying Low Bone Density

DXA is more effective than standard X-rays in detecting low bone density, which enables early intervention in conditions such as osteoporosis. The precise measurement of bone mineral density by DXA helps identify individuals at risk of fractures and supports targeted treatment approaches.

Low Radiation Dose

DXA uses a low radiation dose, ensuring patient safety during repeated examinations. The minimized radiation exposure makes DXA a favorable choice compared to other imaging techniques that may involve higher radiation doses.

Shorter Scan Times and Lower Cost

DXA scans are relatively quick and take around 25 seconds to complete. This short scan time enhances patient comfort and allows for increased throughput in clinical practice. Additionally, DXA is a cost-effective imaging option compared to other modalities like computed tomography, making it more accessible for routine use.

Limitations of X-ray Absorptiometry

DXA is an invaluable tool for assessing bone mineral density and body composition. However, it is important to recognize its limitations and potential pitfalls. Discrepancies in measurements can arise due to analytic differences between manufacturers and models. Moreover, DXA bone measures may be prone to error in individuals with obesity, which can decrease the accuracy of the obtained bone measures. Other limitations include:

Inability to Differentiate Between Trabecular and Cortical Bone

DXA cannot differentiate between trabecular and cortical bone, limiting its ability to provide comprehensive information on bone microarchitecture. Other imaging techniques, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), are more suitable for assessing specific bone microstructural properties.

Preparing for a DXA Scan

A DXA scan is a quick and painless procedure. Patients should inform their healthcare provider of any recent imaging studies involving contrast material, as it may interfere with the DXA results. No other specific preparations are necessary for the scan.

Possible Errors in BMD Acquisition

Errors can occur during the acquisition of BMD measurements, including improper positioning or movement during the scan. These errors can lead to inaccurate results and emphasize the need for meticulous attention to detail during the scanning process.

Technical Inaccuracies and Discrepancies in BMD Interpretation

Despite its accuracy, DXA may present technical inaccuracies and discrepancies in interpreting bone mineral density (BMD) results. Factors such as patient positioning, artifacts, and device-related issues can introduce errors in BMD acquisition, emphasizing the importance of adhering to proper procedures and guidelines.

X-ray Absorptiometry with Scintica

At Scintica, our team is composed of highly qualified professionals with diverse educational backgrounds, specializing in various fields such as Imaging, Pharmacology, Biology and Medical Sciences, Chemistry, Neurology, Oncology, Cardiology, and Nanotechnology. With our collective expertise, we are dedicated to providing comprehensive support to researchers to make breakthroughs in understanding and treating metabolic disorders, advancing scientific knowledge, and human health. 

One of our key products is the iNSiGHT DXA system, which is an advanced in vivo Dual-Energy X-Ray Absorptiometry technology for preclinical research. It evaluates metabolic disorders, osteoporosis, arthritis, diabetes, obesity, and musculoskeletal pathologies. Some of its key features include the following:

  • Fast scan time (25 seconds)
  • Fully shielded X-ray cabinet
  • Low-dose radiation
  • Non-destructive
  • Non-invasive

The iNSiGHT system provides accurate body composition measurements, including bone mineral density, fat and lean mass percentages, and total weight. It’s non-invasive, non-destructive, and allows specific bone length measurements. 

Contact Scintica today to learn more about X-ray Absorptiometry.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378094/

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