Using manufacturers reference data the prevalence of osteoporosis using a T-score threshold of -2.5 for heel measurements by DXL technology was compared to dual-energy X-ray absorptiometry (DXA) measurements at the femoral neck, spine and forearm. The prevalence of osteoporosis for women aged 50 years or older was 28% for DXL measurements of the heel bone and 30, 22 and 32% for DXA measurements of the lumbar spine, femoral neck and forearm respectively. Bone mineral density (BMD) was also measured by DXL in the heel bone and by DXA in spine and femoral neck in 251 women (mean age 62 +/- 14.5 years) when attending an osteoporosis clinic. The sensitivity and specificity for osteoporosis and osteopenia for the DXL measurements were calculated assuming a low T-score at the spine or femoral neck as the criterion for a correct diagnosis. The sensitivity was found to be 80% for osteoporosis and 82% for osteopenia and the specificity was 82% for osteoporosis and 89% for osteopenia. We conclude that DXL measurement at the heel bone, using a T-score threshold of -2.5 for classification of osteoporosis, is in concordance with the World Health Organization (WHO) definition of osteoporosis.