DEXA measurement of spine density in the lateral projection. I: Methodology

Bone mineral content and bone mineral density (BMC in g and BMD in g/cm2) were measured using dual-energy X-ray absorptiometry (DEXA). DEXA scans in the lateral decubitus position required about 12 minutes for the L2-L4 sequence at 0.75 mA (dose 5 mrem) and 4 minutes at 4.75 mA (7 mrem). The former scans were done with the Lunar DPX densitometer and the latter with the Lunar DPX-L. One test of the algorithms used for measurement is the equality of BMC in both AP and lateral projections. BMC in the lateral projection averaged about 1% lower than in the AP projection in phantoms and for L2 + L3 in 8 subjects, but the difference was not significant. Additional tests were done on the effects of tissue thickness and position from the tabletop. There was little or no influence of tissue thickness from 18 to 30 cm on BMD results, but there was a small influence of thickness below 18 cm (0.01 g/cm2; P = 0.01) and of distance from the tabletop at extremes of positioning (0.02 g/cm2; P = 0.06). The precision in vivo was similar for both 4- and 12-minute scans; the standard deviation of repeat measurements was about 0.02 g/cm2, which was about 2% relative to the mean BMD for a region within the vertebral body. The latter region included half the BMC of the body, or 24% of the entire vertebra. Results of 4-minute scans on the DPX and 12-minute scans on the DPX-L in 9 subjects were highly correlated (r = 0.98; P less than 0.001).