Radiofrequency echographic multi‑spectrometry for the in‑vivo assessment of bone strength: state of the art—outcomes of an expert consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)

Adolfo Diez‑Perez1, Maria Luisa Brandi2,3, Nasser Al‑Daghri4, Jaime C. Branco5, Olivier Bruyère6, Loredana Cavalli2,3, Cyrus Cooper7, Bernard Cortet8, Bess Dawson‑Hughes9, Hans Peter Dimai10, Stefano Gonnelli11, Peyman Hadji12, Philippe Halbout13, Jean‑Marc Kaufman14, Andreas Kurth15,16, Medea Locquet17, Stefania Maggi18, Radmila Matijevic19,20, Jean‑Yves Reginster4,6, René Rizzoli21, Thomas Thierry22,23

Published: Aging Clinical and Experimental Research. 2019 Oct; 31(10):1375-1389


The impact of osteoporosis and the resulting bone fracture on both patient’s life and healthcare systems is constantly increasing and innovative tools for early diagnosis and monitoring of this disease are urgently needed. Bone mineral density (BMD) measurement are now based on Dual-energy X-ray Absorptiometry (DXA), but reported limitations of this technique boosted the scientific research to identify reliable and accurate alternative approaches.

To address the actual unmet clinical needs, a working group convened by the European Society of Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) reviewed the data on the currently available imaging techniques for the in vivo bone strength assessment and discussed principles, applications and perspectives of the innovative Radiofrequency Echographic Multi-Spectrometry (REMS) technology.

In this work, they show how REMS represents the first clinically available method for direct non-ionizing measurement of lumbar and femoral BMD, being an accurate diagnostic parameter for bone strength estimation and identification of individuals at high risk of fracture. Moreover, REMS has shown a further potential in the assessment of skeletal fragility based on bone structure quality through the Fragility Score parameter, which is independent from the densitometric evaluation.


1 Department of Internal Medicine, Hospital del Mar/IMIM and CIBERFES, Autonomous University of Barcelona, Passeig Maritim 25‑29, 08003 Barcelona, Spain
2 FirmoLab Fondazione F.I.R.M.O., Florence, Italy
3 Department of Biological, Experimental and Clinical Science, University of Florence, Florence, Italy
4 Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
5 NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
6 WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
7 MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
8 Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
9 Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
10 Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
11 Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
12 Frankfurter Hormon und Osteoporose Zentrum, Frankfurt, Germany
13 International Osteoporosis Foundation, Nyon, Switzerland
14 Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
15 Department of Orthopaedic Surgery and Osteology, Klinikum Frankfurt, Frankfurt, Germany
16 Mayor Teaching Hospital, Charite Medical School, Berlin, Germany
17 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
18 National Research Council, Aging Program, Institute of Neuroscience, Padua, Italy
19 Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
20 Clinical Center of Vojvodina, Clinic for Orthopedic Surgery, Novi Sad, Serbia
21 Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
22 Department of Rheumatology, Hospital Nord, CHU St Etienne, St Etienne, France
23 INSERM 1059, University of Lyon, St Etienne, France

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