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Insights Imaging. 2017 Jun;8(3):311-317. doi: 10.1007/s13244-017-0553-6. Epub 2017 Apr 21.

A critical appraisal of the quality of adult dual-energy X-ray absorptiometry guidelines in osteoporosis using the AGREE II tool: An EuroAIM initiative.

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Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
Department of Health Sciences, University of Genova, Genoa, Italy.
Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136, Bologna, Italy.
Department of Radiology, Saint-Antoine Hospital, Paris, France.
University of Genova and AOU IRCCS San Martino IST, Genoa, Italy.
Department of Radiology, University of Foggia, Foggia, Italy.
Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy.
Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.



Dual energy X-ray absorptiometry (DXA) is the most widely used technique to measure bone mineral density (BMD). Appropriate and accurate use of DXA is of great importance, and several guidelines have been developed in the last years. Our aim was to evaluate the quality of published guidelines on DXA for adults.


Between June and July 2016 we conducted an online search for DXA guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II instrument. A fifth independent reviewer calculated scores per each domain and agreement between reviewers' scores.


Four out of 59 guidelines met inclusion criteria and were included. They were published between 2005 and 2014. Three out of four guidelines reached a high level of quality, having at least five domain scores higher than 60%. Domain 1 (Scope and Purpose) achieved the highest result (total score = 86.8 ± 3.7%). Domain 6 (Editorial Independence) had the lowest score (total score = 54.7 ± 12.5%). Interobserver agreement ranged from fair (0.230) to good (0.702).


Overall, the quality of DXA guidelines is satisfactory when evaluated using the AGREE II instrument. The Editorial Independence domain was the most critical, thus deserving more attention when developing future guidelines.


• Three of four guidelines on DXA had a high quality level (>60%). • Scope/purpose had the highest score (86.8 ± 3.7%). • Editorial Independence had the lowest score (54.7 ± 12.5%). • Interobserver agreement ranged from fair (0.230) to good (0.702).


Agree; DXA; Dual-energy X-ray absorptiometry; Evidence based medicine; Guidelines

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