OBJECTIVES: One of the latest developments in bone densitometry is peripheral quantitative computed tomography (pQCT), a method which allows the separate determination of cortical and trabecular bone mineral density (BMD) in the peripheral skeleton. This study was designed to compare the relative abilities of single-photon absorptiometry (SPA) and pQCT to reflect BMD of the proximal femur as measured by dual-energy X-ray absorptiometry (DXA), an established predictor of osteoporotic hip fracture risk. DESIGN: Cross-sectional study. SUBJECTS: A well-defined community-based sample of 129 skeletally healthy women aged 70-87 years. MEASUREMENTS: Radial BMD by SPA and pQCT and femoral BMD by DXA. Univariate and multivariate regression analyses were performed relating the DXA measurements at the femoral neck and the trochanteric region with the values of SPA and pQCT. RESULTS: Approximately 38% of the variance in femoral neck BMD could be explained by BMD of the midradius assessed by SPA, in contrast to only 18-27% by pQCT. At the trochanter, 32% of BMD could be predicted by SPA as compared to 19-26% by pQCT. Moreover, according to multiple regression, prediction of femoral BMD by SPA was not enhanced by performing pQCT. CONCLUSIONS: Radial pQCT has little value as a screening tool to identify elderly women with low femoral BMD. Additional research is needed to determine whether or not pQCT will enhance fracture prediction beyond that obtainable from a density measurement by SPA.