Skeletal Radiology

, Volume 47, Issue 8, pp 1111–1117 | Cite as

Peripheral DXA measurement around ankle joint to diagnose osteoporosis as assessed by central DXA measurement

  • Ki Hyuk Sung
  • Young Choi
  • Gyeong Hee Cho
  • Chin Youb Chung
  • Moon Seok ParkEmail author
  • Kyoung Min Lee
Scientific Article



This study evaluated the correlation between central and peripheral bone mineral density (BMD) of the ankle joint, using dual-energy X-ray absorptiometry (DXA). We also investigated whether peripheral ankle BMD could be used to identify individuals who were diagnosed with osteoporosis, using central DXA.


We recruited 134 volunteers aged 20–90 years who agreed to participate in this study. Central BMD of the lumbar spine and left femur, and peripheral BMD of the medial malleolus, distal tibia, lateral malleolus, and talus were measured with DXA.


Among the peripheral sites of the ankle, the highest and lowest BMD were observed in the talus and lateral malleolus, respectively. All peripheral DXA measurements of the ankle joint were significantly correlated with central DXA measurements. There was a good correlation (r: 0.656–0.725) between peripheral and central BMD for the older age group (> 50 years), but fair-to-good correlation (r: 0.263–0.654) for the younger age group (< 50 years). The cut-off values for peripheral BMD of the ankle joint between osteoporosis and non-osteoporosis were 0.548 g/cm2 (sensitivity, 89.0%; specificity, 69.0%) for the medial malleolus, 0.626 g/cm2 (sensitivity, 83.3%; specificity, 82.8%) for the distal tibia, 0.47 g/cm2 (sensitivity, 100.0%; specificity, 65.5%) for the lateral malleolus, and 0.973 g/cm2 (sensitivity, 72.2%; specificity, 83.6%) for the talus (p < 0.001).


This study showed good correlation between peripheral BMD around ankle joint and central BMD for older age group. Further study is required to use the ankle DXA as a valid clinical tool for the diagnosis of osteoporosis and fracture risk assessment.


Osteoporosis Bone mineral density Dual-energy X-ray absorptiometry Peripheral Central Ankle joint 



This study was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT (2017M3A9D8064200) and by SNUBH research fund (grant no. 13-2014-007).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

256_2018_2876_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© ISS 2018

Authors and Affiliations

  • Ki Hyuk Sung
    • 1
  • Young Choi
    • 2
  • Gyeong Hee Cho
    • 1
  • Chin Youb Chung
    • 1
  • Moon Seok Park
    • 1
    Email author
  • Kyoung Min Lee
    • 1
  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSungnamSouth Korea
  2. 2.Department of Orthopaedic SurgeryKosin University Gaspel HospitalBusanSouth Korea

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