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Osteoporosis and osteopenia are diagnosed most commonly by evaluating the lowest T-score of BMD measurements, typically taken at three sites the L1-L4 lumbar spine, femoral neck, and total hip. This study aimed to evaluate the effect of using all three BMD measurements and multivariate statistical theory to evaluate how the diagnoses of osteoporosis and osteopenia change in simulation studies and in real data. First, it was found that the T-scores from these three BMD measurements rarely give concordant diagnoses using the same World He