Comparative diagnostic performance of dual-energy X-ray absorptiometry and other radiological modalities in osteoporosis detection: a systematic review.

A serious worldwide health issue, osteoporosis is characterized by weakened bones and a higher risk of fracture. Though alternative imaging modalities like quantitative ultrasound (QUS), radiographic absorptiometry (RA), quantitative computed tomography (QCT), and radiofrequency echographic multispectrometry (REMS) have emerged as viable diagnostic or screening tools, dual-energy X-ray absorptiometry (DEXA) is still the gold standard for measuring bone mineral density (BMD). The purpose of this systematic review was to evaluate the clinical usefulness, diagnostic accuracy, and dependability of different radiographic modalities for osteoporosis detection. In order to find papers published between 2001 and 2023 comparing DEXA with other radiographic modalities for osteoporosis diagnosis, a thorough search of the PubMed, Scopus, and ScienceDirect databases was undertaken. There were ten studies that qualified. Study design, demographic characteristics, imaging methods, diagnostic thresholds, and performance metrics (sensitivity, specificity, and correlation coefficients) were among the data that were extracted. Across studies, DEXA consistently demonstrated high precision and strong correlation with fracture risk, confirming its role as the reference standard. QUS showed moderate agreement with DEXA, supporting its use as a screening tool but not for diagnostic confirmation. RA provided good reproducibility but lower sensitivity compared with DEXA. QCT exhibited superior sensitivity (up to 91%) and early trabecular bone detection but was limited by higher cost and radiation exposure. Emerging evidence for REMS demonstrated strong correlation with DEXA (r = 0.85-0.90), comparable diagnostic accuracy, and the advantage of being radiation-free and portable. DEXA remains the gold standard for osteoporosis diagnosis; however, QCT and REMS show promising diagnostic accuracy and may complement DEXA for early detection and longitudinal monitoring. QUS and RA can serve as cost-effective screening tools, particularly in settings where DEXA is unavailable. Further large-scale, prospective studies with standardized diagnostic thresholds are needed to validate these findings and optimize imaging strategies for osteoporosis management.