The reliability of dual-energy X-ray absorptiometry measurements of bone mineral density in the metatarsals

Objective: To investigate the reliability of a simple, efficient technique for measuring bone mineral density (BMD) in the metatarsals using dual-energy X-ray absorptiometry (DXA). Materials and methods: BMD of the right foot of 32 trained male distance runners was measured using a DXA scanner with the foot in the plantar position. Separate regions of interest (ROI) were used to assess the BMD of each metatarsal shaft (1st–5th) for each participant. ROI analysis was repeated by the same investigator to determine within-scan intra-rater reliability and by a different investigator to determine within-scan inter-rater reliability. Repeat DXA scans were undertaken for ten participants to assess between-scan intra-rater reliability. Results: Assessment of BMD was consistently most reliable for the first metatarsal across all domains of reliability assessed (intra-class correlation coefficient [ICC] ≥0.97; coefficient of variation [CV] ≤1.5 %; limits of agreement [LOA] ≤4.2 %). Reasonable levels of intra-rater reliability were also achieved for the second and fifth metatarsals (ICC ≥0.90; CV ≤4.2 %; LOA ≤11.9 %). Poorer levels of reliability were demonstrated for the third (ICC ≥0.64; CV ≤8.2 %; LOA ≤23.6 %) and fourth metatarsals (ICC ≥0.67; CV ≤9.6 %; LOA ≤27.5 %). BMD was greatest in the first and second metatarsals (P < 0.01). Conclusion: Reliable measurements of BMD were achieved for the first, second and fifth metatarsals.