Journal of Clinical Densitometry · Oct 2026

Age-related Reference Data for Cortical and Trabecular 3D-DXA Parameters: the SEIOMM-3D-DXA Project

By Casado E, Di Gregorio S, Valero C et al.

Introduction Osteoporosis and associated hip fractures are a major public health concern. Dual-energy X-ray Absorptiometry (DXA) remains the diagnostic gold standard, but its areal (a) bone mineral density (BMD) measurements have limited sensitivity, as many fractures occur at T-scores above -2.5. Three-dimensional (3D) DXA provides compartment-specific volumetric parameters of the hip, potentially improving osteoporosis management. This study aimed to establish reference data for 3D-DXA parameters and investigate potential compartmental imbalances at the hip. Methodology This multicenter, cross-sectional observational study (SEIOMM-3D-DXA project), supported by the Spanish Society for Bone and Mineral Metabolism (SEIOMM), analyzed hip DXA scans from men and women across six centers in Spain. 3D-DXA analyses were conducted using the 3D-Shaper software (3D-Shaper Medical, Barcelona, Spain), producing estimates of trabecular volumetric (v) BMD and cortical surface (s) BMD. Age- and sex-specific reference curves were generated using the LMS method, and thresholds were established based on regression with aBMD T-score values. Moreover, trabecular vBMD and cortical sBMD Z-scores were calculated to evaluate potential compartmental imbalances. Results Age-related reference curves were created using data from 1362 subjects (1011 women and 351 men). The aBMD curves closely aligned with the NHANES III Caucasian reference curves. Sex-specific thresholds for trabecular vBMD and cortical sBMD were established for patient stratification. Z-score comparisons revealed significant inter-compartment differences, defined as absolute differences exceeding the least significant change, in 52.0% of women and 48.7% of men, highlighting the potential value of compartment-specific bone assessment. Conclusions This study establishes reference curves for clinical interpretation of 3D-DXA parameters and demonstrates the potential of 3D-DXA to capture compartmental imbalances at the hip.

doi.org/10.1016/j.jocd.2026.101778 Open access, accepted manuscript Biomarkers