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Does a DEXA repeated every sixteen weeks give me a usable lean-mass trend?

Asked 25 Feb 2025Modified 13 months agoViewed 16k times
23

I would like to know what to measure as much as what to do.

These are treated as interchangeable and I do not think they are.

If both are acceptable I would like to know that, so I can stop thinking about it.

Is there a defensible reason to prefer one, or is this a coin flip?

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dexa

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askedper_haugen13k1725 Feb 2025
Same machine both times? Otherwise the comparison is between machines. – Dr_Hanne_Solberg 8 months ago
Voting to keep this open — it is more specific than it first looks. – tenth_of_a_unit 6 months ago
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5 Answers

Accepted answer first, then by votes
11

Accepted answer

16 weeks is 112 days, and the only question is whether 16 weeks accumulates more signal than the instrument's own noise. Scan-to-scan precision on lean mass is about one to one and a half per cent under standardised conditions, so on a 60 kg lean mass the least significant change is roughly 0.9 kg. At half a kilogram of total loss a week with a quarter of it lean — 0.125 kg of lean per week — 16 weeks accumulates 2 kg. 2 kg clears the 0.9 kg threshold, so a repeat every 16 weeks resolves a real change rather than reporting its own error. That is the interval to use. Standardised means the same machine, the same time of day, the same hydration state, the same clothing. Change any of those and the precision figure this arithmetic rests on is no longer yours. Three scans on a line beat two scans and a difference at any interval: the third is what tells you whether the second was a measurement or an outlier.

On the detail: this is an instrument question rather than a physiology question, and treating it as one resolves most confusion in this tag.

Radiation exposure is very low — of the order of a few microsieverts, comparable to a day or two of natural background — so scan frequency is limited by cost and by precision, not by dose.

Protein target arithmetic

Body mass1.2 g/kg1.6 g/kg2.0 g/kgPer meal at 1.6 (÷3)
62 kg74 g99 g124 g33 g
74 kg89 g118 g148 g39 g
88 kg106 g141 g176 g47 g
103 kg124 g165 g206 g55 g
124 kg149 g198 g248 g66 g

At roughly 4 kcal per gram, 141 g of protein is about 564 kcal — a substantial fraction of a 900 kcal budget, which is the real constraint.

The underlying point is that scanning more often than every twelve to sixteen weeks generally produces changes inside the precision error, which reads as noise and gets interpreted as signal.

Between-manufacturer differences in body-composition output on the same subject are documented in cross-calibration studies and are not small.

A body-fat percentage from one machine and one from another are not the same measurement and should never be compared.

Ask the facility for its precision error. If it does not have one, that is information.

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answered · acceptedDr_Yusuf_Adeyemi54k14717 Mar 2025
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9

Answer first: dual-energy X-ray absorptiometry is precise and only conditionally accurate, so it is excellent for tracking change on the same machine and poor for comparing an absolute number against someone else's.

Hydration is the dominant confounder. A litre of fluid is a kilogram, and it is allocated mostly to the lean compartment, so an under-hydrated scan flatters the body-fat percentage and a post-carbohydrate-loading scan does the opposite.

In practice, bone mineral density falls modestly during sustained weight loss, and having the baseline on the same series is the only cheap way to see it.

Appendicular skeletal muscle mass index from DXA is the confirmatory measure in the consensus sarcopenia definitions.

Precision is good, accuracy is conditional. Track change, do not compare absolutes.

edited 9 Mar 2025 by plate_count_9k — fixed an arithmetic slip in the third paragraph

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answeredplate_count_9k78k2485 Mar 2025
8Is the twenty-five per cent figure from surgical cohorts or from dietary ones? – e_dziedzic 5 months ago
Any published number for how long the counter-regulatory response persists? – Dr_Priya_Raghunathan 6 months ago
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5

On the detail: regional analysis — trunk versus limbs — is more informative than the total for anyone tracking training effects.

Standardise: same scanner, morning, twelve hours fasted, no exercise in the preceding twenty-four hours, no unusual carbohydrate intake in the preceding two days, and the same clothing.

Put another way, scans are usually reported with a total and with regional segments. Regional lean mass in the limbs is the appendicular skeletal muscle measure used in the sarcopenia definitions, and it is more useful than the total for training questions.

DXA precision error and least-significant-change calculations are standard quality metrics published by densitometry societies and by well-run facilities.

Same machine, same conditions, twelve weeks apart. Anything else is noise collection.

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answerednils_karlberg9.4k1520 May 2025
2

Put another way, bone mineral density comes free with the scan and is worth reading, particularly during sustained weight loss.

Different manufacturers use different edge-detection and tissue-decomposition algorithms, so cross-machine comparisons can differ by several percentage points of body fat on the same person on the same day.

Bioimpedance is not a substitute and is far more sensitive to hydration than DXA is.

Read the regional segments, not just the total.

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answeredDr_Wren_Halliday19k3722 Jun 2025
7Thank you — this is the answer I was looking for. – v_ramaswamy 7 months ago
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-3

The honest answer is that a single scan tells you very little and a series of three tells you a great deal.

Typical precision error on a good DXA is around one per cent for fat mass and one to two per cent for lean mass, which means the least significant change is roughly two and a half to three per cent — about one to one and a half kilograms of lean mass for most people.

Effective dose for a whole-body composition scan is published at a few microsieverts, well below a chest radiograph.

Nothing here is medical advice.

Take the bone density seriously; it is the part of the scan nobody reads.

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answeredDr_Yusuf_Adeyemi54k14711 Jun 2025

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