Is There a Better Way to Test Our Bone Strength?

Back in September 2021, a blog titled "Osteoporosis Testing: There's A New Kid in Town" described a relatively new bone density test called REMS (Radiofrequency Echographic Multi Spectrometry), made by a company called Echolight (the test is sometimes referred to by the company name). REMS uses ultrasound to measure bone density and quality at the hip and spine.

Since that report, more promising research has emerged indicating REMS is not only accurate but also creates a Fragility Score (FS), independent of bone mineral density (BMD), to help estimate skeletal fragility. Echolight's matrix combines BMD and bone quality data to determine five-year fracture risk. Pisani and colleagues found "FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk."

While DXA (Dual Energy X-ray Absorptiometry) remains the "gold standard" for diagnosing osteoporosis/osteopenia among most medical experts, many errors can occur during DXA testing (e.g., improper positioning) and in interpretation.

REMS may overcome some DXA limitations:

• Even though DXA radiation exposure is very small, REMS has no radiation at all.
• BMD and quality evaluation are included within the REMS software package, whereas DXA requires an additional software package (trabecular bone score) that's often not available with many DXA scans.
• Degenerative changes (arthritis) or scoliosis in the spine do not affect REMS results, whereas they can falsely elevate DXA readings.
• REMS can monitor people at much younger ages — important if there's concern that adequate peak bone density (met by or before age 30) hasn't been reached.
• REMS is not as operator-dependent as DXA in terms of accurately positioning the patient.
• The REMS machine is easily portable, and results are available within minutes.

Is REMS ready for prime time? The short answer is yes. Cleared by the FDA in 2018, REMS gives another useful, accurate data point for bone health decisions. Currently not many US facilities offer REMS testing, but this is expected to gradually change — it's non-ionizing, cheaper, easier to use, and quick. As of this writing, one highly regarded practice in Doylestown, PA offers REMS testing (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.
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. (This study included sixteen authors; three own stock in Echolight and one is a scientific advisor at Echolight; the remaining twelve authors declared no competing interests.)
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.