Leg muscle assessment by HR-pQCT and DXA: associations between imaging measures and muscle function in adults with obesity-a pilot study.
13 affiliations
- 1Department of Endocrinology, Esbjerg and Grindsted Hospital, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark.
- 2Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark.
- 3Department of Regional Health Research, University of Southern Denmark, 5230 Odense M, Denmark.
- 4Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States.
- 5Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, United States.
- 6Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States.
- 7Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC 27109, United States.
- 8Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27104, United States.
- 9Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States.
- 10McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada.
- 11Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 4Z6, Canada.
- 12Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada.
- 13Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States.
Abstract
DXA and HR-pQCT are used for bone assessment but also image adjacent soft tissue. This pilot study examined association between HR-pQCT-measured leg muscle cross-sectional area (CSA) and density vs DXA-derived lean mass, and explored associations with muscle strength, power, and physical performance in adults with obesity. Patients eligible for bariatric surgery (BMI ≥ 30 kg/m²; ages ≥30) received baseline HR-pQCT (XtremeCT II) and DXA (Hologic) scans. HR-pQCT scans of the non-dominant leg were acquired at 30% of tibial length and processed using a custom Python script for muscle segmentation, followed by manual editing. Whole-body DXA scans were analyzed to extract lean mass for the total leg and subregions analogous to the HR-pQCT. Functional measures included gait speed (400-m walk), muscle power (12-step stair climb), and knee extensor strength (isokinetic dynamometer). Pearson correlations assessed relationships between imaging modalities and functional measures. Among 28 adults (ages: 47.7 ± 8.6; BMI: 43.8 ± 4.6 kg/m²), HR-pQCT muscle CSA and density averaged 36.0 ± 4.8 cm² and 60.1 ± 8.1 HU, respectively. DXA lean mass was 2.23 ± 0.40 kg for the total leg and 0.107 ± 0.019 kg for the 30% site. HR-pQCT muscle CSA correlated moderately with DXA lean mass (r = 0.57-0.69, p = .0017-<.0001), whereas HR-pQCT muscle density showed negligible correlations with DXA lean mass (r = -0.01-0.04, p = .84-0.96). Significant positive correlations were observed for DXA total leg lean mass with absolute muscle power (r = 0.40) and HR-pQCT muscle CSA with knee strength (r = 0.41; both p < .05). In adults with obesity, HR-pQCT and DXA may provide complementary measures of leg muscle quantity, with moderate association for CSA and lean mass, but limited associations with muscle density. Body weight and whole-body lean mass showed stronger correlations with stair climb power (r = 0.42-0.70) than localized leg muscle measures (r = 0.17-0.40). Muscle density and muscle quantity may capture different aspects of musculoskeletal health, warranting further investigation in larger samples.
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BibTeX
@article{gam2026muscle,
title = {{Leg muscle assessment by HR-pQCT and DXA: associations between imaging measures and muscle function in adults with obesity-a pilot study.}},
author = {Søren Gam and Joshua R Stapleton and Vivian Jing and Eric Zeng and S Delanie Lynch and Nina Z Heilmann and Kristin Cattell and Lori S Cogdill and Catherine MacLean and Sherri A Ford and Marjorie J Howard and Daniel P Beavers and Jamy D Ard and Steven K Boyd and Ashley A Weaver and Kristen M Beavers},
journal = {JBMR plus},
year = {2026},
month = sep,
doi = {10.1093/jbmrpl/ziag158},
url = {https://europepmc.org/article/MED/42847042},
note = {CC BY},
}
RIS
TY - JOUR
TI - Leg muscle assessment by HR-pQCT and DXA: associations between imaging measures and muscle function in adults with obesity-a pilot study.
AU - Søren Gam
AU - Joshua R Stapleton
AU - Vivian Jing
AU - Eric Zeng
AU - S Delanie Lynch
AU - Nina Z Heilmann
AU - Kristin Cattell
AU - Lori S Cogdill
AU - Catherine MacLean
AU - Sherri A Ford
AU - Marjorie J Howard
AU - Daniel P Beavers
AU - Jamy D Ard
AU - Steven K Boyd
AU - Ashley A Weaver
AU - Kristen M Beavers
PY - 2026
DA - 2026/09/22
JO - JBMR plus
DO - 10.1093/jbmrpl/ziag158
UR - https://europepmc.org/article/MED/42847042
AB - DXA and HR-pQCT are used for bone assessment but also image adjacent soft tissue. This pilot study examined association between HR-pQCT-measured leg muscle cross-sectional area (CSA) and density vs DXA-derived lean mass, and explored associations with muscle strength, power, and physical performance in adults with obesity. Patients eligible for bariatric surgery (BMI ≥ 30 kg/m²; ages ≥30) received baseline HR-pQCT (XtremeCT II) and DXA (Hologic) scans. HR-pQCT scans of the non-dominant leg were acquired at 30% of tibial length and processed using a custom Python script for muscle segmentation, followed by manual editing. Whole-body DXA scans were analyzed to extract lean mass for the total leg and subregions analogous to the HR-pQCT. Functional measures included gait speed (400-m walk), muscle power (12-step stair climb), and knee extensor strength (isokinetic dynamometer). Pearson correlations assessed relationships between imaging modalities and functional measures. Among 28 adults (ages: 47.7 ± 8.6; BMI: 43.8 ± 4.6 kg/m²), HR-pQCT muscle CSA and density averaged 36.0 ± 4.8 cm² and 60.1 ± 8.1 HU, respectively. DXA lean mass was 2.23 ± 0.40 kg for the total leg and 0.107 ± 0.019 kg for the 30% site. HR-pQCT muscle CSA correlated moderately with DXA lean mass (r = 0.57-0.69, p = .0017-<.0001), whereas HR-pQCT muscle density showed negligible correlations with DXA lean mass (r = -0.01-0.04, p = .84-0.96). Significant positive correlations were observed for DXA total leg lean mass with absolute muscle power (r = 0.40) and HR-pQCT muscle CSA with knee strength (r = 0.41; both p < .05). In adults with obesity, HR-pQCT and DXA may provide complementary measures of leg muscle quantity, with moderate association for CSA and lean mass, but limited associations with muscle density. Body weight and whole-body lean mass showed stronger correlations with stair climb power (r = 0.42-0.70) than localized leg muscle measures (r = 0.17-0.40). Muscle density and muscle quantity may capture different aspects of musculoskeletal health, warranting further investigation in larger samples.
SN - 2473-4039
ER -