The effect of fat on the measurement of bone mineral density by digital X-ray radiogrammetry (DXR-BMD).

OBJECTIVE: We have previously shown that surrounding fat causes an increase of up to 21% in bone mineral density (BMD) measured by Lunar 'Intelligent DXA' (iDXA), one of the latest generation dual energy X-ray absorptiometry (DXA) scanners [1]. The purpose of our study was to see if it was possible to avoid this artifact when measuring the BMD of metacarpals II, III, and IV by digital X-ray radiogrammetry (DXR). METHODS: We took X-rays of the bones of a cadaveric left hand which were immobilized in a wooden cradle to preserve an approximate in vivo configuration. The X-rays were digitized into Digital Imaging and Communications in Medicine (DICOM) files which were analyzed using dxr-online (dxr-online, Sectra, Sweden) which uses the same DXR-BMD algorithm previously used by Pronosco X-posure v2 and Sectra Osteoporosis package. The X-rays were repeated four times. We then surrounded the bones with a layer of lard, and again X-rayed four times. This process was repeated with the bones were covered by two layers, and then three layers of lard. RESULTS: The measured DXR-BMD increased by a maximum of 0.44% when the metacarpals were covered by either two or three layers of lard compared with when the metacarpals were not covered by lard. CONCLUSION: The measurement of metacarpal BMD measured by DXR is minimally affected by surrounding lard. The measurement of metacarpal BMD by DXR seems to be a way of avoiding the artifactual change in BMD caused by fat, when it is measured by DXA.