DEXA Predicts Diabetes and ASCVD Risk In Postmenopausal Women

The use of dual-energy x-ray absorptiometry (DEXA) to determine the percent of total-body and trunk fat (%TrF) is a better predictor than traditional clinical measures of obesity in postmenopausal women to predict the risk of diabetes and atherosclerosis-related cardiovascular diseases (ASCVDs), according to a study published online August 31, 2021, in Mayo Clinic Proceedings.

DEXA-derived body fat measures were compared against the traditional measures of obesity: body-mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). The study consisted of 9744 postmenopausal women aged 50-75 who were part of the Women’s Health Initiative, underwent a DEXA scan, and were free of cardiovascular disease during baseline assessments spanning October 1993 to December 1998, according to lead author Deepika Laddu, Ph.D. of the University of Chicago, Illinois. The study participants were tracked through September 2015.

“A total of 1327 diabetes cases, 1266 atherosclerotic cardiovascular disease (ASCVD) cases, 292 heart failure cases, and 1811 deaths from any cause accrued during a median follow-up of up to 17.2 years. The largest hazard ratio observed per 1 standard deviation increase of an adiposity measure was for %TrF and diabetes (1.77; 95% CI, 1.66-1.88) followed by %TrF and broadly defined ASCVD (1.22; 95% CI, 1.15-1.30). These hazard ratios remained significant for both diabetes (1.47; 95% CI, 1.37-1.57) and ASCVD (1.22; 95% CI, 1.14-1.31) even after adjusting for the best traditional surrogate measure of adiposity, WC. Percentage of trunk fat was also the only adiposity measure to demonstrate statistically significant improved concordance probability estimates over BMI, WC, and WHR for diabetes and ASCVD (all P<0.05)," wrote the team in their abstract.

They concluded that ” DXA-derived estimates of abdominal adiposity in postmenopausal women may allow for substantially improved risk prediction of diabetes over standard clinical risk models.” Though they acknowledge that more study is needed. “Larger DXA studies with complete lipid biomarker profiles and clinical trials are needed before firm conclusions can be made,” they wrote.


Deepika R. Laddu, FeiFei Qin, Haley Hedlin, Marcia L. Stefanick, JoAnn E. Manson, Oleg Zaslavsky, Charles Eaton, Lisa Warsinger Martin, Thomas Rohan, Themistocles L. Assimes. “DXA Versus Clinical Measures of Adiposity as Predictors of Cardiometabolic Diseases and All-Cause Mortality in Postmenopausal Women.” Mayo Clinic Proceedings. Available online 31 August 2021. Accessed September 15, 2021, at

Morton, Will. “DEXA predicts diabetes in obese menopausal women.” September 7, 2021. Accessed September 15, 2021, at