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Our purpose was to investigate any potential effect of neck flexion on measurement of spinal bone mineral density (BMD) through further reduction of spinal lordosis and whether it is necessary to apply a head positioner, in addition to a leg positioner, during dual-energy x-ray absorptiometry. Methods Fifty-nine patients with no significant history of spinal disorders were recruited. A bone densitometry scan of the spine was obtained for all patients using a standard leg positioner in the supine position. Then, another scan of the spine