Survey finds that 25% of DXA facilities reported not being accredited by professional or government organizations; adherence to many basic DXA quality assurance and reporting procedures was confirmed by less than 50% of services.

There is high variability in access to, and quality of, bone density scanning facilities worldwide, according to a landmark global study carried out at the Medical Research Council Life course Epidemiology Unit (MRC LEU, University of Southampton) in collaboration with the International Osteoporosis Foundation (IOF) and the International Society for Clinical Densitometry (ISCD).

global survey of 121 fracture liaison services (organisations which identify and provide treatment for patients at risk of secondary fractures) from 31 countries was conducted to assess the quality of their bone scanning facilities. These services participated in the Capture the Fracture® Best Practice Framework which provides globally-endorsed standards for fracture liaison services.

Low bone density, measured using Dual-energy X-ray absorptiometry (DXA), is common among older people and is associated with increased risk of osteoporotic fractures. Osteoporotic fractures are associated with disability, mortality and significant economic costs.

The study, published in Osteoporosis International, found that most fracture liaison services reported that DXA access met needs. However, adherence to basic DXA quality and reporting procedures was confirmed by only around 50% of services and over 50% required ongoing education for DXA machine operators and interpreters.

Professor Christopher Shuhart, co-author and Immediate Past President of ISCD stated:

"Although DXA service access meets needs, many centres are falling short of quality standards. The findings emphasise the need for educational initiatives targeting DXA measurement technology and reporting, such as adoption of the joint IOF-ISCD Osteoporosis Essentials course."

Professor Cyrus Cooper, Director of the MRC LEU and President of IOF, said:

"This unique, ground-breaking study is exactly the sort of health quality assessment required in our field. It is a wonderful example of collaboration between IOF and ISCD to generate a unique global perspective."


  1. Clynes, M.A., Westbury, L.D., Dennison, E.M. et al. Bone densitometry worldwide: a global survey by the ISCD and IOF. Osteoporos Int (2020). This study was funded by the following organisations: International Society for Clinical Densitometry; International Osteoporosis Foundation; UK Medical Research Council; University of Southampton.
  2. Osteoporosis Essentials: Densitometry, Diagnosis and Management Course: This joint IOF-ISCD global course covers the latest knowledge on densitometry, diagnosis and management of osteoporosis, with separate tracks for Clinicians and Technologists. An Attestation of Achievement is awarded to all participants who successfully complete the course and the examination.
  3. Capture the Fracture®: A global programme to facilitate the implementation of coordinated, multi-disciplinary models of care for  secondary fracture prevention. 
  4. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top one per cent of institutions globally.  Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 24,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni.
  5. The Medical Research Council is at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Thirty-two MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms.
  6. The International Osteoporosis Foundation (IOF) is the world’s largest organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related fragility fractures. As a not-for-profit Foundation which unites more than 260 patient and medical societies, as well as 164 of the world’s leading key opinion leaders and experts, IOF is the highly respected and influential voice at the helm of the global musculoskeletal community. Together, this constituency works towards the IOF vision of a world without fragility fractures in which healthy mobility is a reality for all.
  7. The International Society for Clinical Densitometry (ISCD) is dedicated to advancing high-quality musculoskeletal health assessments in the service of superior patient care.