Calibration of dual-energy x-ray absorptiometry for bone density

Bone mineral content (BMC, g) using DEXA (Lunar DPX) was measured on known hydroxyapatite samples in a water bath in the presence of uniform and nonuniform covering of fat-equivalent materials. Selective placement of paraffin over bone had a greater effect than lard in reducing apparent BMC, and polycarbonate plastic had a lesser effect. Measured BMC was 100.1 +/- 1.1% of actual hydroxyapatite weight when (1) fat over bone was about twice the mass of hydroxyapatite, and (2) the surrounding soft tissue was 15-30% fat. There was a linear relationship between observed and expected BMC, area (cm2), and bone mineral density (BMD, g/cm2) measured on an aluminum phantom using either the Lunar DPX or the Hologic QDR-1000. The measured area with the two densitometers was identical, but BMC differed. For both an anthropomorphic phantom and human subjects, use of a constant-threshold (0.2 g/cm2) edge-detection algorithm excluded less low-density bone from the transverse processes than the standard DPX edge-detection algorithm. Differences in edge detection could influence the results obtained with phantoms and in vivo and make system intercomparison difficult.