REMS vs DXA

Does Radiofrequency Echographic Multi-Spectrometry (REMS) perform similarly to Dual-energy X-ray Absorptiometry (DXA) in terms of Trabecular Bone Score (TBS) and FRAX?

Débora Meira Ramos Amorim, Eliane Naomi Sakane,  Sergio Setsuo Maeda, Marise Lazaretti-Castro.

Departamento de Medicina, Divisão de Endocrinologia, Universidade Federal de São Paulo, São Paulo, SP, Brasi

Published: Archives of Endocrinology and Metabolism (Official Journal of the Brazilian Society of Endocrinology and Metabolism)

HIGHLIGHT:

REMS performed similarly to DXA in assessing trabecular integrity using TBS. Additionally, no statistically significant difference was observed in fracture risk assessment by FRAX based on NOGG recommendations.

The recent study “Does Radiofrequency Echographic Multi-Spectrometry (REMS) perform similarly to Dual-energy X-ray Absorptiometry (DXA) in terms of Trabecular Bone Score (TBS) and FRAX? “ published in Archives of Endocrinology and Metabolism, the official journal of the Brazilian Society of Endocrinology and Metabolism, by the Professor Lazzaretti Castro’s research team, evaluated whether bone assessment by REMS was influenced by trabecular bone integrity by comparing it DXA and TBS. Additionally, the study aimed to determine if comparing fracture risk using FRAX and the National Osteoporosis Guideline Group (NOGG) using the T-score from each method would lead to differences in a Brazilian female population, including individuals from diverse ethnic backgrounds and clinical conditions.

The obtained results showed that REMS performed similarly to DXA in assessing trabecular integrity using TBS. Half of the exams classified as normal by DXA but osteopenic by REMS were classified as partially degraded or degrad­ed by TBS, suggesting that REMS might be more asser­tive in identifying bone microarchitecture.”The particular importance of this study lies in showing the similarities between REMS and DXA and in identifying the discordant cases where REMS may have detected the impaired bone quality shown by TBS” the researchers stated.

Additionally, the FRAX risk probabilities calculated using REMS or DXA did not show statistical differences, which may be of interest for clinical practice. The intervention thresholds for osteoporosis treat­ment defined by the FRAX-NOGG strategy using the femoral neck T-score obtained by REMS were not dif­ferent from those obtained using the DXA femoral neck T-score. Previously, the authors have reported the high accura­cy of REMS for diagnosing DXA-defined osteoporosis in this same sample of women. These findings suggest that REMS performs similarly to DXA and may become a surrogate method for diagnos­ing osteoporosis and fracture risk stratification using FRAX.

Finally, REMS device is less expensive than a DXA densitometer, but there is still room for price reduction as it becomes more commercialized. In addition, it is portable, meaning it can be transported to different diagnostic centers covering larger geographic regions, increasing the population’s access to the exam and, consequently, to the diagnosis of osteoporosis. It is simpler to perform than DXA and as it does not contain ionizing radiation, there are no restrictions regarding radiological protection or technicians’ exposure.

In conclusion, the obtained results suggest that REMS could offer significant advantages in osteoporosis diagnosis, combining effectiveness and practicality and its ability to detect microarchitectural degradation allows for a more precise assessment of fracture risk.