Huge difference between DEXA and REMS

[HealthELiving]

In August of this year, my DEXA scan T-score readings were:

Left femoral neck: -2.3, left hip overall: -2.0

Right femoral neck: -2.5, right hip overall: - 2.3

Spine: -0.9

Nov.27 - only 3 months later and working on bone health through exercise and nutrition/supplements, I got a REMS scan at Sanford, NC and the results were horrifying:

It shows:

Left femoral neck: -3.5, left hip overall: -3.0

Right femoral neck: -3.3, right hip overall: - 2.8

Spine: -3.1

Has anyone else experienced this huge dicotomy of results? Which is 'true'? How could it be SO very different? On the plus side (if there is one), my bone strength indicator from REMS was decent, but this is disturbing to say the least? Thoughts?

[Fruitandnutcase]

Gosh, that is a huge difference- did you discuss it with Nick (assuming it was him you saw) when you had the REMS done? If so what did he say? I’d tend to think it was more likely to be operator error for the DEXA but who knows.

[HealthELiving in reply to Fruitandnutcase]

yes it is, and I would tend to think that the Dexa was inaccurate, combined with the medical facility that told me no action was needed based upon the result (osteopenia 10 years ago until this past scan which indicated the 1st occurrence of osteoporosis ). I had the scan in the U.S. and have an appointment on 12/18 to discuss this with the orthopedic surgeon who runs the test facility.

[Kaarina]

So you had this REMS done in North Carolina?

[HealthELiving in reply to Kaarina]

yes.

[DMG73]

I have had differing results between rems and dexa but my dexa results were always worse. I was told this was because I'm petite and dexa is not accurate for my size. I think you need to determine why you have such a difference between your hips and spine in your dexa result. I was told they should be similar as bone is laid down everywhere at the same amount. To me the dexa data looks to be poor and should be repeated.

[HealthELiving in reply to DMG73]

I am also petite. 104 lbs 5'2. This is so confusing and disturbing at the same time. Most reports I read mirrored yours where the details was always higher.

[aintbrokeyet in reply to HealthELiving]

I recently had a REMS 6 months after my DEXA. My total hip score was the same on both scans -2.6, and spine was better on the REMS from -3.5 on DEXA to -3.0 on REMS. I am also petite 5 ft. 1.5 in. and 125 lbs. I was hesitant to trust the improved REMS spine score, but have read that the REMS is not prone to error and more reliable.

[Soozie_C]

Do you have osteoarthritis? OA can skew the DEXA results apparently. My hip scores were worse on the REMS scan because I have osteoarthritis.

[HealthELiving in reply to Soozie_C]

I was not told I had oa. How would I know?

[Soozie_C in reply to HealthELiving]

You would know I think. You lose movement and flexibility in the joint and it can be painful.

[ZeeD23]

I had a DEXA scan taken 4 years ago, with similar hip scores to your DEXA. I had a REMS scan this year which gave similar hip scores to your REMS scan. (My spinal REMS score showed a slight improvement over the DEXA score.) In my case, there was a 4 year gap between the two scans, so I guess it’s possible that my hips have deteriorated in the meantime, but I find this a little surprising, given that I have throughout this period been doing all the “right” things: lots of impact exercise, including running, weights training, good nutrition and recommended supplements, and even the wretched alendronic acid for 3 years (couldn’t bear it after that!). I’ve always been a fit, athletic person, so I’ve decided simply to carry on and try not to worry!

My question about REMS scans is that, if they are such a good alternative to DEXA, why are they not more widely used, either in the UK, or the USA, or anywhere in Europe (except Italy, where they do seem to be used more widely). After all, the equipment is massively cheaper, highly portable, and operators appear not to require a lot of technical training. You’d think the NHS would be hugely in favour. It may be that it’s because the DEXA gives an actual measurement based on the penetration, and speed of penetration, of the X-rays, whereas the REMS measurement (if I’m reading the info correctly) is algorithmic: that is, the scatter pattern on the ultrasound image is compared to other patterns on a database to achieve a reading. But I’m not a scientist, and I’m open to correction! I found the following scientific article useful:

ncbi.nlm.nih.gov/pmc/articl... technology is a non,vertebrae and/or femoral neck.

One thing that does seem to be clear is that those with smaller or slimmer bones seem to get worse ratings out of both systems.

[HealthELiving in reply to ZeeD23]

I fear that the factor of 'human error' is possibly prevelant with both. They both depend upon calibration and in the case of DXA, proper positioning of the patient. The margin of error can make a huge difference as in my case and yours, if the REMS was more accurate. I am also active and adjusting nutrition, supplements, exercise, etc. but have not yet accepted a drug therapy as I had not thought it was so far progressed until the REMS scan was performed.

[aintbrokeyet in reply to HealthELiving]

I've had personal experience with a DEXA error 4 years ago when my DEXA showed an improved spine score from -2.8 to -2.4 after being on Prednisone for autoimmune condition for 1 year doing no exercise! I had had a DEXA one year previously, but knew nothing about osteoporosis and potential for DEXA error etc. at that time. Evidently, neither did my GP as she didn't question the results and believed my spine score had improved despite the Prednisone, then scheduled my next DEXA for 3 years later. Based on what I now know, I have no doubt the improved DEXA score was an error.

[restlesspegs in reply to ZeeD23]

I've had 3 DEXA scans, at 2 locations with different operators. The results were almost identical between scans/machines.

I also had a REMS scan which showed a far better score for my femoral neck, barely osteopenia.

I fractured my femoral neck from a fall as a 37 year old male.

For me, I really don't trust the REMS results. The typical response after an improvement is that the REMS is more accurate for petite people. However, I'm 6'2 and 95kg.

[Fruitandnutcase in reply to restlesspegs]

Would the better score for your femoral neck not be because it had healed completely by the time you had your REMS scan?

[restlesspegs in reply to Fruitandnutcase]

All scans were on the non-fractured side. They couldn't scan the fractured side as it had 3 huge cannulated screws in.

[Fruitandnutcase in reply to restlesspegs]

🤔 Hmmm who knows. Did you ask the person who did your REMS why they thought that was?

[restlesspegs in reply to Fruitandnutcase]

I was told the DEXA was innacurate and at the time, I'd only had one.

I've since had 2 more, one on the same machine and 1 elsewhere with a different machine and technician and unfortunately, the scores are all very close and nowhere near my REMS score.

[Fruitandnutcase in reply to restlesspegs]

You wouldn’t know what to think would you.

[CDreamer]

Yes- but mine was the other way around! My score on REMS showed osetiopenia not osteoporosis.

The doctor who did my REMS (UK) said he tracked the various NHS operators in the major hospitals and could predict their individual error scores. My understanding is that REMS is more accurate.

Did your doctor also do a fragility score? Numbers are meaningless, fragility assessment for fragility fractures which taken together with your REMS scan which determines your risk. All my broken bones were from hard impact falls and my overall risk of fragility fractures is low average for my age range, I therefore declined drugs.

[HealthELiving in reply to CDreamer]

It seems most who post here share your experience with the reversal of numbers. The REMS also calculates fragility scoring (bone strength ) and that was good. I have a discussion with the physician who operates the facility to review on 12/18 to gain some perspective and path. It is most distressing that the past 6 years of Dexa scans were so inaccurate and my PCPs instructed no action needed as it only revealed osteopenia (which frankly, I should have been instructed to do more to build bone and bone strength.. wish I knew!)

[CDreamer in reply to HealthELiving]

I received excellent guidelines and nutrition sheet. I have a Marodyne and had been using once a day but told twice a day to be effective.

[HealthELiving in reply to CDreamer]

Thank you. I am happy you were well cared for. I have a lifepro but really do not know if it is at all comparable to Marodyne. What nutritio al advice do you feel helped you?