Back in September 2021, I wrote a blog titled “Osteoporosis Testing: There’s A New Kid in Town” , which described a relatively new test for measuring bone density called REMS, which stands for Radiofrequency Echographic Multi Spectrometry. The company that manufactures this equipment is Echolight, and you’ll sometimes hear this test referred to by the company name. Simply put, REMS uses ultrasound to measure bone density and quality at the hip and spine (1).
Since my last report, more promising research has emerged, and it largely indicates that REMS is not only accurate, but also creates a Fragility Score (FS) which is independent of bone mineral density (BMD) and helps to estimate skeletal fragility. The information that’s gathered is BMD and bone quality, and Echolight has developed a matrix that puts the two together to determine a five-year fracture risk. Pisani and colleagues determined that “FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk” (2).
While most medical experts in the field still consider DXA (Dual Energy X-ray Absorptiometry) to be the “gold standard” for diagnosing osteoporosis and low bone mass (osteopenia), it is also understood that many errors can occur not only during this test, (such as improper positioning), but also in the interpretation of the test (3).
REMS may be able to overcome some of the limitations of DXA:
- Even though the radiation exposure with DXA is very small, there is no radiation with REMS.
- The evaluation of BMD and quality is included within the REMS software package, whereas DXA requires an additional software package to assess bone quality called the trabecular bone score. This is often not available with many DXA scans.
- Degenerative changes (arthritis) or scoliosis in the spine do not affect the REMS results. When these conditions are present, the DXA results can appear falsely higher.
- REMS testing can monitor people at much younger ages which is important if there is concern that adequate peak bone density has not been met. (This occurs by or before age 30.)
- REMS scanning is not as operator dependent as DXA in terms of accurately positioning the patient.
- The REMS machine is easily portable.
- The results of the REMS test are available within minutes.
Is REMS ready for prime time?
The short answer is yes!
Cleared by the FDA in 2018, REMS gives us another very useful and accurate data point to help make decisions regarding our bone health.
Currently there aren’t too many facilities that offer REMS testing in the United States, but I expect this to gradually change. It’s non-ionizing, cheaper, easier to use, and quick. So far, I know of one highly regarded practice in Doylestown PA that offers this test.
If you’re interested, please reach out using the following website: https://www.qualisos.com
References
1. Cortet B, et al. Radiofrequency Echographic Multi Spectrometry (REMS) for the Diagnosis of Osteoporosis in a European Multicenter Clinical Context. Bone 2021 Feb; 143. (PubMed, View PDF)
2. Pisani P, et al. Fragility Score: A REMS-based Indicator for the Prediction of Incident Fragility Fractures at 5 Years. Aging Clinical and Experimental Research 2023 Apr;35(4):763-773. (PubMed, View PDF)
(This study included sixteen authors. Three of them own stocks in Echolight and one is a scientific advisor at Echolight. The remaining twelve authors have no competing interests to declare.)
3. Krueger D, et al. DXA Errors Are Common and Reduced by Use of a Reporting Template. Journal of Clinical Densitometry: Assessment and Management of Musculoskeletal Health 2019; 22(1): 115-124. (PubMed)