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This is consistent with the lower aBMD from DXA at the lumbar spine than at the total hip.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      X-linked osteoporosis due to\n                      <jats:italic>PLS3<\/jats:italic>\n                      genetic variants is a rare disease, clinically affecting men more than women. This study aimed to explore relationships between parameters obtained from DXA, high-resolution peripheral quantitative computed tomography (HR-pQCT), and 3D-DXA in thirteen adults with\n                      <jats:italic>PLS3<\/jats:italic>\n                      variants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The parameters were for 3D-DXA: trabecular volumetric bone mineral density (Tb.BMD), cortical surface BMD (Ct.sBMD), and bone strength at the total hip using 3D-DXA-based finite element models (3D Shaper\u00ae software, v2.14.0), and for HR-pQCT: Tb.BMD, cortical volumetric BMD (Ct.BMD), and bone strength at the distal radius and tibia using micro-finite element analysis. Results were compared with normative data of the scanner system (DXA) or from literature (3D-DXA, HR-pQCT) and expressed as median\n                      <jats:italic>Z<\/jats:italic>\n                      -scores. Spearman correlations were determined between the different parameters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      aBMD at the lumbar spine was numerically lower (median\n                      <jats:italic>Z<\/jats:italic>\n                      -score \u2212 1.7) than at the total hip (\n                      <jats:italic>Z<\/jats:italic>\n                      \u22121.3). 3D-DXA revealed a low Tb.BMD (\n                      <jats:italic>Z<\/jats:italic>\n                      \u22121.9), while Ct.sBMD was less affected (\n                      <jats:italic>Z<\/jats:italic>\n                      \u22121.0). HR-pQCT also showed a lower Tb.BMD (\n                      <jats:italic>Z<\/jats:italic>\n                      \u22121.9 at the radius and \u22122.5 at the tibia) than Ct.BMD (\n                      <jats:italic>Z<\/jats:italic>\n                      \u22120.4 and \u22121.3, respectively). 3D-DXA parameters were highly correlated with each other (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and with aBMD. No significant correlations were found between any of the 3D-DXA and HR-pQCT parameters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Both HR-pQCT and 3D-DXA showed lower trabecular than cortical BMD in individuals with\n                      <jats:italic>PLS3<\/jats:italic>\n                      variants, in line with the lower aBMD at the lumbar spine than at the total hip. Studies in larger cohorts and other bone disorders are needed to examine relationships between imaging modalities and their ability to predict bone fragility.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11657-026-01656-2","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T14:16:45Z","timestamp":1769005005000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship between bone mineral density and strength derived from 3D-shaper and HR-pQCT in patients with X-linked osteoporosis related to PLS3"],"prefix":"10.1007","volume":"21","author":[{"given":"Z.","family":"Zervou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Mabrouk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. F. 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Zervou, R. Mabrouk, M.S.A.M. Bevers, and J.P. van den Bergh declare that they have no conflict of interest. E. Alizadeh received the CPP2021-008574 grant, funded by the Spanish Ministry of Science and Innovation (MICINN) and the Spanish Research Agency (AEI), which supported a research project in collaboration between Pompeu Fabra University and 3D-Shaper Medical S.L. E.F.S. van Velsen reports honoraria for lectures from Amgen, U.C.B., and Kyowa Kirin, which are unrelated to this work. M.C. Zillikens reports honoraria for lectures and consulting from Amgen and Kyowa Kirin and Theramex and research support from Kyowa Kirin to her institution, unrelated to this work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}],"article-number":"27"}}