Diagnostics for Bone Disease Taking the High Road or the Low Road to Standardization

Each year the incidence of osteoporosis-related fractures in women is greater than the incidence of heart attacks, strokes, and breast cancer combined. Over 44 million people in the U.S. have low bone mass that places them at increased risk for osteoporosis. Hip fracture incidence alone will increase 2-3 fold by 2040 according to predictions from the Surgeon General's office. Dual-energy x-ray absorptiometry (DXA) measurement of bone mineral density is the primary diagnostic for assessing bone health and related diseases such as osteoporosis. However, DXA has shortcomings that limit its usefulness in diagnosing bone disease and monitoring therapies, not the least of which is the lack of measurement standards.  How has DXA been so successful in the face of these limitations? What benefits can be achieved from standardization? A review of the technology and past standardization initiatives provides perspective on pathways forward for this valued tool.