Body composition (BC) measured by dual X-ray absorptiometry (DXA) differs between devices. We aimed to compare regional and total BC measurements assessed by the Hologic Horizon A™ and the GE Lunar iDXA™ devices; to determine device-specific calibration equations for each BC parameter; and to assess the impact of this standardization procedure on the assessment of sarcopenia, lipedema, obesity and cardiovascular risk with DXA. A total of 926 postmenopausal women (aged 72.9 ± 6.9 years, height 160.3 ± 6.6 cm, weight 66.1 ± 12.7 kg) underwent BC assessment on each device within one hour, following the ISCD guidelines. The included sample was split into 80% train and 20% test datasets stratified by age, height and weight. Inter-device differences in BC parameters were assessed with Bland–Altman analysis, Pearson or Spearman correlation coefficients and t-tests or Wilcoxon tests. The equations were developed in the train dataset using backward stepwise multiple linear regressions and were evaluated in the test dataset with the R-squared and mean absolute error. We compared the abovementioned BC-derived health conditions before and after standardization in the test set with respect to relative risk, accuracy, Kappa score and McNemar tests. Total and regional body masses were similar (p > 0.05) between devices. Bone mineral content was greater for all regions in the Lunar device (p < 0.05), while fat and lean masses differed among regions. Regression equations showed high performance metrics in both datasets. The BC assessment from Hologic classified 2.13 times more sarcopenic cases (McNemar: p < 0.001), 1.39 times more lipedema (p < 0.001), 0.40 times less high cardiovascular risk (p < 0.001) and similarly classified obesity (p > 0.05), compared to Lunar. After standardization, the differences disappeared (p > 0.05), and the classification metrics improved. This study discusses how hardware and software differences impact BC assessments. The provided standardization equations address these issues and improve the agreement between devices. Future studies and disease definitions should consider these differences.
