title: The reliability of dual-energy X-ray absorptiometry measurements of bone mineral density in the metatarsals.
abstract: 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).
  
  
  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).
  
  
  CONCLUSIONS
  Reliable measurements of BMD were achieved for the first, second and fifth metatarsals.
authors.affiliation: Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia. joel.fuller@mymail.unisa.edu.au.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Fuller
authors.affiliation: Medical Radiation, School of Health Sciences, University of South Australia, Adelaide, Australia, 5001.
authors.forename: Jane
authors.initials: J
authors.lastname: Archer
authors.affiliation: Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Buckley
authors.affiliation: Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
authors.forename: Margarita D
authors.initials: MD
authors.lastname: Tsiros
authors.affiliation: Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
authors.forename: Dominic
authors.initials: D
authors.lastname: Thewlis
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000465:Algorithms; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging* / Q000502:physiology*; D015203:Reproducibility of Results; D012420:Running / Q000502:physiology*; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Bone mineral density; Dual-energy X-ray absorptiometry; Metatarsal; Reliability