Hi folks, this is my first post and I'm new to this site but I've been doing heaps of reading and research into T-scores thrown up by DEXA scans. I run a pilates studio and work with many people with OP and osteopænia so, as part of my work, I do a lot of reading!
I'm coming across a lot of people are told that their DEXAs shows (for example) osteoporosis in the spine but osteopenia in the hip and they're been told they need to take medication to treat the osteoporosis.
OP is a systemic condition. Unless there is a good reason for it not to be, in normally mobile people bone density should be reasonably uniform through the spine and lower limbs. If a DEXA result shows a T-score difference of greater than 1.0 or if the diagnostic category of the two areas is different e.g., osteopænia in the hip and osteoporosis in the spine, this is a "discordance".
Some discordances are minor because of the way bone density results are presented. For instance, a T-score of -2.4 at the hip is rated as osteopænia but a T-score in the spine of -2.5 is osteoporosis. This represents a minor discordance as the actual bone density of the two areas is very similar. These minor discordances occur equally frequently with both DEXA and REMS.
However, DEXA seems to have a much higher rate of major discordances where a person might be told they have normal bone in one area and osteoporosis in the other, or the difference between T-scores is much greater than 1.0.
One in twenty DEXA scans are affected in this way. Read that again
The commonest reason for these discordant results is operator technique when the DEXA scans are performed.
For the first 1000 REMS scans performed by OsteoscanUK the rate of major discordances has been 0% because the REMS scan results are not operator-dependent. All REMS scan/scan appointments are carried out by bone health specialist and spinal consultant, Mr Nick Birch (GMC No 3086328 if anyone needs to know!), so operator/interpretational mistakes just don't happen! I personally this think this is the main USP for REMS.
In almost every case of a major discordance thrown up by DEXA they (OsteoscanUK) have come across, their REMS scans are able to resolve the problem and frequently shows that a diagnosis of osteoporosis in one site and osteopænia at the other is incorrect and both sites are actually classed as osteopænia.
REMS is quickly becoming the go-to scan system to have for this, and many other, reasons. It originated from Italy and now has been included within the Guidelines published by the National Institute of Health in Italy for the management of Fragility Fractures. It's only a matter of time before the UK is the same. GPs are becoming more aware of the "failings" of the DEXA system and REMS is the ideal replacement.
Sorry for the long post!