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Unlike public awareness around the world, osteoporosis is still underdiagnosed in most cases till bone fractures. Currently, the dual-energy X-ray absorptiometry DEXA is the gold standard diagnostic method of osteoporosis, but unfortunately this method is not available in all diagnostic centers, especially in developing countries. To evaluate the accuracy of tibial cortical thickness in the diagnosis of osteoporosis compared with DEXA. In this descriptive--analytic study, patients suspicious of osteoporosis who referred to Imam Khomeini Hospital, Ahvaz from were recruited. Data was collected for each patient including age, sex, radiography, and DEXA. The total thickness of the tibia cortex sum of the two sides was measured using knee anteroposterior radiography at 10 cm from the proximal tibial joint. The mean age of the patients was 57 years range years. Also, the sensitivity and specificity for the TCT level less than 4. It has also been shown that TCT can be a relatively accurate diagnostic tool for predicting osteoporosis.