REMS Performance

The very recent study titled “Proposed practice parameters for the performance of radiofrequency Echographic multispectrometry (REMS) evaluations” and published on the Bone Joint Open by international key Opinion Leaders from USA and UK showed that REMS are becoming a commonplace technology in primary and secondary healthcare environments, adding to clinicians’ ability to accurately measure bone health parameters in a timely way.

These practice parameters provide a robust framework for clinicians who offer REMS services, particularly related to orthopedic interventions, to work within, which should ensure accurate and reproducible diagnostic results with direct benefit from REMS scan and for bone health status monitoring in special populations, such as fractured or bedridden subjects, pregnant females, and young people.

The paper highlights that while DXA has served to screen and monitor changes in BMD over the last 40 years, it has a multitude of shortcomings including lack of portability, inability to evaluate the quality of bone if the trabecular bone score (TBS) is not applied, radiation exposure, reporting or measurement errors, and the necessity to follow BMD changes on the same scanner to minimize measurement error. DXA cannot be used in, or fails to provide accurate assessment, in many circumstances, including pregnancy, scoliosis, the presence of degenerative changes in the spine or hip, very high or very low BMI, or when there are issues that can affect patient positioning.In contrast, based on its advanced signal analysis, REMS can exclude polymethylmethacrylate cement artifacts from the analysis, as well as the biased estimation of BMD in cases of osteoarthritis and osteophytes.

REMS has a robust evidence base that demonstrates its equivalence to DXA in determining BMD at axial sites. Fracture prediction using REMS, combining the output of fragility information and BMD, has been established as more accurate than when using BMD aloneIn addition, considering cost comparisons, REMS and DXA were evaluated through a process of qualitative expert analysis to determine what the relative costs were in the Italian National Health Service. REMS was found to be less expensive as a method to evaluate bone densitometry than DXA.

A further study in the USA found REMS to be a cost-effective strategy for the diagnosis of osteoporosis treatment in the USA with substantial potential economic benefits REMS has recently been extensively reviewed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) Working Group, which concluded that the published evidence shows it is a useful tool in the management of osteoporosis and is a suitable alternative to DXA. Its portability and lack of ionizing radiation means it can be used in previously underserved populations, including pregnant women and children. It will also have an increasing role in assessing bone health parameters in frail, hospitalized patients, in fracture clinics, primary care, the emergency department, and even at home.

It is ideal for deployment in clinical situations remote from hospital, such as in geographically isolated and resource-poor areas. Added to these attributes, the ability of REMS to measure bone quality in both hips and the spine, which provides greater accuracy of fracture prediction, makes it unique among the available densitometry technologies.

The practice parameters described in this protocol form a framework for REMS providers that will, to the greatest possible extent, ensure the most accurate assessment possible from the technology.