Bone mineral densitometry (BMD) using dual-energy x-ray absorptiometry (DEXA) has been widely adopted as the standard method of assessing bone density. Although not intended to be a primary imaging modality, the technique generates attenuation map images that are used to guide region-of-interest placement. Artifacts and incidental findings are frequently encountered on the DEXA images, some of which directly affect BMD values and others that are only of incidental importance to clinical practice. We systematically review a variety of artifacts and incidental findings that may be encountered on DEXA, illustrated by a collection of findings from our own practice. Being cognizant of these unexpected abnormalities, and understanding their etiology, will prepare the reader to more readily appreciate significance of these findings when seen in clinical practice.