DXA technology has evolved from pencil beam to fan beam, allowing short acquisition time and improved image quality. In clinical practice, ‘areal’ bone mineral density (BMDa; g/cm2) assessment of lumbar spine (L1–L4), proximal femur (femoral neck and total hip) and forearm (distal) is made by central DXA. Interpretation of BMDa measurements is based on the World Health Organisation (WHO) recommendations. Osteoporosis can be diagnosed if the value of BMDa is 2.5 or more standard deviations (SD) below the mean value of a young reference population (T score at or below −2.5). Central DXA can also provide whole-body imaging for total and regional BMDa, body composition (lean muscle and fat mass) and VFA. Total body imaging is useful for the assessment of the growing skeleton and forearm imaging can be performed in patients with hyperparathyroidism [8]. DXA at peripheral sites can be performed using either general purpose body DXA or smaller dedicated peripheral DXA for measurements in peripheral skeletal sites. Using device-specific thresholds peripheral DXA may play a role in identifying those at risk of osteoporotic fracture, especially when there is limited or no access to central DXA.