Pitfalls and sources of error in DXA reporting and interpretation: The role of age-associated comorbidities,...

The study's aim was to evaluate DXA scanning and reporting errors in the femur and lumbar spine, focusing on older adults.

A physiatrist followed the ISCD-2023 guidelines when analysing DXA scans, noting errors relating to positioning, analysis, or artefacts, and conducting a demographic evaluation. For analysis, the cohort was divided into younger (<65 years) and older (≥65 years) adults; findings were evaluated separately by group and region (lumbar/hip).

The analysis included 3,475 participants (6,826 DXA reports: 3,398 lumbar, 3,428 hip), 1,850 younger and 1,625 older. Among 6,826 DXA scans, 12.5% had no errors. Error rates differed by age and region: lumbar (12.1% error-free) vs. hip (11.5% error-free). Positioning errors affected 3.9% (spinous process alignment) and 19.6% (hip rotation) of scans. Analysis errors included vertebral marking (0.2%) and Ward triangle detection (0.2%). Degenerative/artifact-related errors were more frequent in older adults (16.2% lumbar, 0.3% hip) versus younger (2.7% lumbar, 0.3% hip). Common artifacts included degenerative changes (9.0% lumbar), foreign objects (0.4%), and calcifications (0.2%). Older adults had higher rates of spinal mispositioning (10.9% vs 6.8%) and hip rotation errors (23.6% vs 16.0%) compared to younger adults.

Errors and quality deviations are exceptionally common (overall prevalence 87.5%; affecting 88.1% of older compared to 87.0% of younger adults), with older-adult scans often influenced by degenerative/structural changes, artefacts and positioning issues. Standardisation, staff training and quality control are needed to improve accuracy for high-risk osteoporosis patients. Protocols tailored to older adults may help reduce these pitfalls.