The Roles of DEXA, Sonography, CT, and MRI in Imaging and Diagnosing Osteoporosis

George Tsoukatos, BPS, RT(R)

*Medical Imaging Consultant, Germantown, NY

Address correspondence to: George Tsoukatos, BPS, RT(R), Radiology Support Services, PO Box 215, Germantown, NY 12526. Email:

Disclosure statement: George Tsoukatos reports having no significant financial or advisory relationships with corporate organizations related to this activity.


By 2040, it is predicted there will be 80 million adults over the age of 65 in the United States, and with advanced age comes the higher probability of being at risk for or being diagnosed with osteoporosis (OP). This statistic coupled with the underestimation of this disease process in men, as well as the effect of certain cancer drugs, likely lead to an exponential increase in the number of older patients developing OP or osteopenia. OP is becoming an increasingly concerning public health issue, but effective interventions and treatments for fragility fractures are now available. Digital radiographic techniques allow clinicians to visualize bone structure. Unfortunately, they do not offer information about bone mineral density (BMD), which can facilitate early diagnosis and treatment of patients with OP. In contrast, bone densitometry helps detect bone mineral loss at an early stage, because it provides accurate quantitative measurement of BMD. Dual X-ray absorptiometry is generally considered to be the gold standard in the assessment of patients' BMD to determine the risk of fracture and monitor treatment effectiveness. Other imaging and quantitative techniques used to analyze bone quality include quantitative computed tomography (QCT), high-resolution peripheral QCT, magnetic resonance imaging, and quantitative ultrasonography. This course will cover current techniques to measure BMD, describe novel techniques to study bone quality, and focus on how standard imaging techniques should be used to establish BMD values for initial treatment and follow-up. This course will also review basic imaging concepts and terminology for each modality discussed and review the anatomic structures and bones that are typically imaged when evaluating a patient for OP. 

(Editor's Note: Some states do not require RTs with certification sub-credentials in bone densitometry to operate DXA imaging systems. Anyone responsible for performing DXA scans will be referred to as DXA system operators, or DXA operators, in this course, even though RTs are performing DXA examinations in most states.)

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