Bone mineral density (BMD) is used in clinical practice as an indirect indicator of osteoporosis and fracture risk1,2. Although the modalities of bone densitometry devices include Dual-energy X-ray Absorptiometry (DXA), Quantitative Ultrasound and Quantitative Computed Tomography, Radiographic Absorptiometry (RA), and Digital X-Ray Radiogrammetry (DXR), the World Health Organization (WHO) recognizes Dual-Energy X-ray Absorptiometry (DXA) as the best densitometric technique for the assessment of BMD. DXA not only helps in accurately diagnosing osteoporosis but also aids in predicting fracture risk and monitoring treatment response2, 3, 4, 5. The primary aim of DXA is to measure BMD accurately and compare it with a reference population of asymptomatic individuals. DXA measurements of BMD are performed using the whole body, lumbar spine, forearm, and proximal femur scans as the reference technique6,7. DXA has advantages including safety, a short examination time, and ease-of-use. DXA measurements are completed within a few minutes and entail minimal radiation exposure. While DXA provides high accuracy in measuring BMD, its sensitivity depends on operators, equipment, and various patient-related factors. In a survey of perceptions among 6,000 members of the International Society for Clinical Densitometry (ISCD), 71% of clinicians and 45% of technicians reported that DXA was misinterpreted at least once a month. Similarly, 98% of clinicians believed that poor-quality reports are harmful to patient care8.

Deficiencies in quality control and calibration, and errors in data collection, analysis and interpretation are common errors in BMD measurements9.The ISCD periodically organizes development conferences to enhance densitometry knowledge, skills, and quality among healthcare professionals, educate and certify clinicians and technicians, raise patient awareness, improve access to densitometry, support clinical and scientific advancements in the field, and promote scientific knowledge exchange10, 11, 12, 13.

To draw attention to common errors in clinical DXA use, many guidelines and reviews are available, two of which are in Turkish. Data acquisition errors related to imaging have been well described in previous studies and include factors such as inappropriate patient positioning, invalid scanning mode, invalid body region, persistent artifacts in scanned areas, and inaccurate demographic information. However, there are few studies on detailed evaluation and error identification of DXA BMD measurements2,7,14,15. The aim of this retrospective descriptive study was to identify common errors in DXA measurements at our hospital, establish standardization, and contribute to operator training.