Background: Regular assessment of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is essential for detecting glucocorticoid-induced osteoporosis in juvenile-onset autoimmune diseases. Z-score is used in children for standardization of osteoporosis assessment. Z-score in children can be evaluated with only one of the three models in Japan. The purpose of this study was to investigate how many domestic medical facilities for pediatric rheumatic diseases could not evaluate osteoporosis using Z-score exist.Methods: Electronic questionnaires were distributed between 2017 and 2019 to hospitals belonging to the Pediatric Rheumatology Association of Japan and to university hospitals and public children' s hospitals that provide medical care for pediatric rheumatic diseases. The questionnaire included the location of DXA measurement, manufacturer (Hologic, GE healthcare, Hitachi), and measurement site, and the answers were collected using Google Forms. Statcel 4 was used for analysis.Results: Overall,120 facilities responded to the survey, of which 117 had DXA. In the remaining three facilities, DXA was not installed in two and was out of order in one. Bone loss in childhood was evaluated using a Z-score calculated from age-based reference values. It was revealed that 30% of hospitals without HOLOGIC DXA could not evaluate osteoporosis by Z-score in Japanese childhood. The characteristics of the hospitals enrolled in this study did not bias the selection of Hologic DXA.Conclusions: Neighboring institutions should consider sharing access to Hologic DXA equipment to ensure the use of uniform reference values. GE BMD reference values for Japanese children should be established.