Standardized diagnostic reference levels (DRL) and systematic quality assurance protocols are essentialfor enhancing radiation safety in dual-energy X-ray absorptiometry (DXA). This study aimed to quantitativelyanalyze radiation exposure from DXA equipment in major Korean hospitals and establish DRL compliant withinternational standards. Eight DXA units from three Seoul hospitals meeting International Society for ClinicalDensitometry (ISCD) recommendations and FDA approval criteria with confirmed quality assurance practices wereselected (GE Lunar Prodigy: 5 units, HOLOGIC Discovery: 3 units). Dose area product (DAP) measurements wereperformed 10 times per unit for spine (L1-L4) and femur (neck) examinations using external DAP meters. Effectivedoses were calculated using conversion factors, and DRL were established based on 75th percentile values. For spineexaminations, mean effective doses were 0.200 μSv for GE Lunar Prodigy and 0.246 μSv for HOLOGIC Discovery,with HOLOGIC showing approximately 23% higher values than GE. For femur examinations, GE demonstrated0.190 μSv while HOLOGIC showed 0.115 μSv, with HOLOGIC approximately 40% lower than GE. The establishedDRL were 0.243 μSv for spine and 0.191 μSv for femur examinations, significantly lower than international referencelevels. Well-maintained DXA equipment with excellent quality assurance can achieve radiation doses substantiallybelow international standards. This study emphasizes the importance of continuous quality assurance and radiationprotection education for minimizing unnecessary exposure while maintaining diagnostic accuracy.