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05-02-2018 | Osteoporosis | Article

Peripheral DXA measurement around ankle joint to diagnose osteoporosis as assessed by central DXA measurement

Skeletal Radiology

Authors: Ki Hyuk Sung, Young Choi, Gyeong Hee Cho, Chin Youb Chung, Moon Seok Park, Kyoung Min Lee

Publisher: Springer Berlin Heidelberg



This study evaluated the correlation between central and peripheral bone mineral density (BMD) of the ankle joint, using dual-energy X-ray absorptiometry (DXA). We also investigated whether peripheral ankle BMD could be used to identify individuals who were diagnosed with osteoporosis, using central DXA.


We recruited 134 volunteers aged 20–90 years who agreed to participate in this study. Central BMD of the lumbar spine and left femur, and peripheral BMD of the medial malleolus, distal tibia, lateral malleolus, and talus were measured with DXA.


Among the peripheral sites of the ankle, the highest and lowest BMD were observed in the talus and lateral malleolus, respectively. All peripheral DXA measurements of the ankle joint were significantly correlated with central DXA measurements. There was a good correlation (r: 0.656–0.725) between peripheral and central BMD for the older age group (> 50 years), but fair-to-good correlation (r: 0.263–0.654) for the younger age group (< 50 years). The cut-off values for peripheral BMD of the ankle joint between osteoporosis and non-osteoporosis were 0.548 g/cm2 (sensitivity, 89.0%; specificity, 69.0%) for the medial malleolus, 0.626 g/cm2 (sensitivity, 83.3%; specificity, 82.8%) for the distal tibia, 0.47 g/cm2 (sensitivity, 100.0%; specificity, 65.5%) for the lateral malleolus, and 0.973 g/cm2 (sensitivity, 72.2%; specificity, 83.6%) for the talus (p < 0.001).


This study showed good correlation between peripheral BMD around ankle joint and central BMD for older age group. Further study is required to use the ankle DXA as a valid clinical tool for the diagnosis of osteoporosis and fracture risk assessment.

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