The Future of Bone Health – Understanding Bone Strength and Bone Density using DEXA and REMS

A REMS ( Radiofrequency Echographic Multi Spectometry ) is radiation- free technology that uses sophisticated ultrasound based technology to assess bone health and bone quality. REMS evaluates not only your bone mineral density (BMD) but also the micro architecture of your trabecular (honeycomb) bone in your spine and femur neck, providing a more comprehensive picture of your bone health. It provides a ‘fragility score’ which is a useful additional component for predicting fracture risk. Its quick, non invasive and regarded as ‘safe’, making it suitable for a wide range of patients for example those with spinal deformity or metal implant.

How does it work?

To be able to test the strength of the bone , REMS processes the unfiltered ultrasound signals acquired during an echographic scan of the femur neck (both left and right) and and spine. Technically it is based on sound waves and sound wave patterns. A mechanical wave is emitted from the probe to a part of the bone which generates a radio free signal. From observing how the sound bounces off the structures deep into the bone, one can build up a picture of how tough or fragile the trabecular bone is. This generates information about the quality and strength of your bone tissue. A bone that is strong emits a different sound wave pattern from a weak bone that is osteoporotic. There are different patterns of sound reflection therefore which can be used to assess bone fragility. This information is analysed and used to determine your fragility score.

This procedure is generally carried out by a consultant orthopaedic surgeon who is best qualified to understand and interpret your results. These health professionals are also able to adjust the settings accurately to suit the geometry and size of the person, particularly if the person is small.

The DEXA

In contrast the DEXA has long been considered the gold standard for measuring bone mineral density. It uses low dose X -rays to quantify bone mass and generate T scores that help diagnose osteoporosis. The dexa scan may not give 100% accurate results as scans can be affected by different factors such as a degenerative condition in the lumbar spine; various machines may be calibrated or set up differently; how the patient is positioned, and variability is also determined by the professional or technician conducting the actual scan. If patients have a repeat scan which is usually every 5 years on average, they are unlikely to have the same operator.

When using the DEXA alone, accuracyin predicting the likelihood of having a bone fracture is to some extent limited because, while the DEXA scan measures bone density, it cannot assess the actual micro architecture of the trabecular bonein the spine and hip.

Combining your bone density and fragility scores together gives you a risk of fracture in the next 5 years. The risk classification is colour coded from green to amber to red. Other aspects to consider are the quality of the bone, its elastic properties and geometry. This extra information gives doctors an improved insight into treating a patient.

Preparation for having a REMs

In terms of preparation you are advised not to eat or drink in the 3 hours prior to your REM. You are advised to wear loose fitting clothes which can be easily adjusted. The procedure is carried out with you lying comfortably on an examination bed while a handheld probe glides over your hip and lower back emitting small bleeps. It takes around 20 minutes or more to have the actual ultrasound but the appointment scheduled for an hour includes a grip strength test, get up and go speed test, height and weight and BMI , and general discussion pertaining to the outcome and the results.

Colour Coded Results

Green zone (Low risk) – This indicates healthy bone density and high quality bone with very low likelihood of sustaining a fracture.

Yellow/Amber zone (Moderate risk) – This suggests potential bone loss, early signs and weakness and moderate risk of fractures.

Red zone (High risk) – This indicates high risk of osteoporosisand a higher likelihood of fracturing a bone.

It is expensive to have this intervention and at present you have to pay privately. It costs £350 in the UK. The cost includes a detailed report and consultation. You are best to book this in advance for your first choice of location within the UK for example : Edinburgh, Glasgow, Newcastle, York. The set up is portable which means the consultants are able to travel to their locations and set up their clinics.

Having been fortunate to have had this scan, I came away feeling more reassured about my osteoporosis prognosis and will in due course be willing to repeat this again at some point in the future. After the initial baseline scan follow ups to monitor your bone health are advised.

To summarise:

Both bone density and fragility strength scores are important in determining risk of fracture.

The DEXA is currently recognised as the gold star tool for assessing bone mineral density. It looks into the surface of the bone to determine bone mineral density surrounding the bone. However the REMS looks deeper into the structure of the bone (3D).

Combining bone density and fragility gives you a risk of fracture in the next 5 years. A diagnosis of osteoporosis is not the end but deciding to manage and reduce the risk of fracture is important. A few steps you can take to maintain what you have, or even better to improve bone density and quality might include a nutritious diet, strength and impact exercise, adequate sleep, and managed stress levels.

Other Advantages of REMS and its future use.

The technology is portable so it can be used in a variety of settings including clinics, and even bed side settings for fragile patients. As the technology continues to evolve and become more widely available it may in time become the standard method for evaluating bone health.

REMS is safe, accurate and non invasive and offers a comprehensive and holistic view of bone health. It is a versatile and useful tool for early diagnosis and monitoring of osteoporosis with no risk of radiation.

Contact www.osteoscanuk.com for more information.