DXA vs REMS

[Knitterbox]

I was diagnosed with osteoporosis in the US following a DXA scan at 56 years of age in May 2023. Spine -2.7 and femoral head -2.6. I live in the US but went to have a REMS scan in the UK when I was back in the summer visiting family. The echo light REMS scan gave me a bone density of -0.9 for my spine (normal) and -1.9 (osteopenia) for my femur. It also showed my bone fragility as good. Has anyone else had such different readings between DXA and REMS? It’s almost impossible to get a REMS scan in the US and most doctors here don’t know anything about it but if the REMS is accurate I don’t need to be on the medication the doctors in the US say I need. Any thoughts or advice would be greatly appreciated.

[restlesspegs]

Yes, my REMs showed similar improvements. However, I fractured my hip from a fall during a run (as a 37 year old male) and have had multiple follow-up DEXAs which all showed similar scores to the original one. So unfortunately, I don't really trust the REMs result.

[Met00 in reply to restlesspegs]

Did you ask why the REMS scores were better than DEXA? Did REMS show good bone quality and, if so, did you ask for an explanation, given that you've had a hip fracture?

[restlesspegs in reply to Met00]

It was implied the REMS score was accurate compared to my first DEXA probably due to placement. However, I've had 2 more DEXA scans since, one on a completely different machine with a different technician and they both had exactly the same score for FN (far lower than REMS).

There are many that seem to blindly put 100% trust in REMS and discount DEXA because of potential inaccuracies despite the fact it's still considered the gold standard and that REMS is far newer with much less scientific data backing it.

[Met00 in reply to restlesspegs]

There is a growing body of evidence in support of REMS, including some large scale studies. The BMA has already recognised its potential. What was your fragility score?

[restlesspegs in reply to Met00]

Fragility score was 11.7.

I'm sure REMS is useful to some, but I see so many people having huge differences between REMS and DEXA testing and they immediately write off the DEXA with zero evidence it's more accurate (when the REMS is more favourable, of course).

At the end of the day, the REMS algorithm was trained using DEXA data and in my opinion, could be considered as supplementary rather than a replacement to DEXA (short of any obvious positioning errors).

[Met00 in reply to restlesspegs]

That sounds an incredibly good fragility score! I'm not surprised you're sceptical if you've fractured, unless of course you've done a lot of work since your fracture to build back bone strength. Where did you have your REMS scan done?

[Raleigh59]

I have bad scores from dexa in feb, and I just did an REMS test in NC and brought it to my top endocrinologist.

He said the REMS gives a lot more info and that my real numbers are closer to REMS than dexa. He still wants me to stay on my medicine but now he’s relaxed and says “ take what you can “

[Finnegan777]

Find Dr. Doug Lucas on YouTube he has information on REMs v dexa scan. I believe he thinks the REMs is superior. I believe you can find the REMs in the United States. search Echolight REMS. the REMS is

also radiation free I heard. With those numbers, I would not go on medication. I would do all I could to strengthen my bones. He’s got a lot of information on how to do that. it’s really disgusting how all the doctors want to do is put you on medication. Osteoporosis is such a Huge problem and yet the doctors know so little or care to know so little. For me I waited too long and my bone scan was bad plus I had vertebral fractures, so I had no choice but to go on medication . when I was diagnosed at 52 years of age with osteopenia is when I should’ve really started working on strengthening my bones but I blew it off.now I am paying the price.

[Frodoles]

What a difference! I can't answer yet about the two different scans. I have an appointment for the REMS early November so will let you know. If you had it with Nick Birch I expect he has given you some advice 😀

[Knitterbox in reply to Frodoles]

I had the Rems scan at profortis sports therapy in Amersham which is another provider in the uk I’ve seen mentioned on this site. Please do let me know what you discover after your REMS scan as I wasn’t prepared for such a big difference in results. I know the US doctors won’t be happy to rely on the REMS results especially as they are so different and DXA is considered the “gold standard”!

[AnnieW55]

DEXA s considered gold standard here too but that’s only because the NHS are so heavily invested in it (and until around 10yrs ago was the only machine measuring bone density) although there are glimmers that things are beginning to change as more people have these scans. The ROS has published a document viewing REMS favourably.

I had a REMS scan with Mr Nick Birch of Osteoscan UK earlier this year and he actually said my two DEXA results looked to have been done correctly, so he doesn’t show bias which is reassuring. He is a spinal consultant and surgeon with many years of experience. My REMS results were broadly in line with the DEXAS and he has said I don’t need another for three years. The good thing about REMS is that it gives a bone strength view (you can have low density with good bone strength and conversely good density with poor strength) and is done with radiation which pleased me as I have had many MRI’s CT (with and without contrast) and X-rays in the last 4 years.

There are many people on the Facebook UK Osteoporosis Friendly Support and Natural Options who have had DEXA’S with wide discrepancies between spine and hip e.g. -3 spine and -2 hip (more than one standard deviation should be rechecked as such differences are suspect).