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Bone densitometry worldwide: a global survey by the ISCD and IOF



In a global survey of fracture liaison services, most reported that DXA access met needs. However, adherence to basic DXA quality and reporting procedures was confirmed by only around 50% of institutions and many required education for operators/interpreters. Overall, there is significant variability in the access to, and quality of, DXA services worldwide.


While the use of dual-energy X-ray absorptiometry (DXA) has been widely adopted worldwide for the assessment of bone mineral density, the quality of DXA facilities is unknown. To address this, a global survey of fracture liaison services (FLS) was conducted by the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) to assess the quality of their DXA facilities.


A questionnaire for the accessibility and quality of DXA services was co-created by representatives of the ISCD and the IOF and made available to institutions who participated in the Capture the Fracture Best Practice Framework. From a list of 331 contacted invitees, 124 FLS centres responded; analyses were based on 121 centres with suitable data.


Over 70% of institutions reported that, for over 90% of the time, DXA access met service needs, and the scanning/reporting quality was perceived as excellent. However, 25% of DXA facilities reported not being accredited by a professional/governmental organization, and adherence to some basic DXA quality assurance and reporting procedures was confirmed by < 50% of services. Importantly, in excess of 50% of institutions stated that they desired ongoing education in osteoporosis and DXA for operators and interpreters.


There is significant variability in the access to and quality of DXA services for established FLS worldwide. Despite two decades of training initiatives in osteoporosis densitometry, many centres are falling short of the standards of the IOF-ISCD Osteoporosis Essentials criteria.

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This study was funded by the following organizations: International Society for Clinical Densitometry; International Osteoporosis Foundation; UK Medical Research Council; University of Southampton.

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Correspondence to C. Cooper.

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Conflicts of interest

MAC reports personal fees (outside the submitted work) from UCB, Pfizer, and Eli Lilly for conference attendance; CC reports personal fees (outside the submitted work) from Amgen, Danone, Eli Lilly, GSK, Kyowa Kirin, Medtronic, Merck, Nestle, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB. EMD reports personal fees (outside the submitted work) from Pfizer Healthcare and from the UCB Discussion panel. NCH reports consultancy, lecture fees and honoraria (outside the submitted work) from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Radius Health and Internis Pharma. JAK reports grants (outside the submitted work) from Radius Health, Amgen and UCB. CRS reports Consultant for Amgen and President of the International Society for Clinical Densitometry (2019–2020). All other authors declare that they have no conflicts of interest.

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Clynes, M.A., Westbury, L.D., Dennison, E.M. et al. Bone densitometry worldwide: a global survey by the ISCD and IOF. Osteoporos Int 31, 1779–1786 (2020).

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  • Bone densitometry
  • Dual-energy X-ray absorptiometry
  • Epidemiology
  • Fracture liaison services
  • Osteoporosis
  • Quality standards