Is anyone familiar with laterial spine bone density?

[FearFracture]

I'm posting this to get a conversation going around the topic of laterial spine bone density.

I was looking through past DEXA reports today and noticed that the report from my first DEXA, which was done in 2019 when I was 50.5 yrs old, includes a laterial spine bone density (none of my other four DEXA show this). It shows a side view of my spine and labels three vertebra, B2, B3, and B4--I'm guessing B2 is my L2 etc. (if I'm wrong about this please correct me).

Following are the t-scores for my lateral spine bone density and my "regular" bone density.

B2 -2.9

L2 -4.3

B3 -4.1

L3 -3.7

B4 -3.2

L4 -3.4

I have a few of questions: has anyone else ever seen their laterial spine bone density? what does it really mean about my spine? and most importantly, they say that DEXAs are areal density not true density because they can't tell the depth of the vertebra, however the laterial spine view does show the depth so why isn't the depth captured in the laterial view used to more accurately calculate the area that is used to calculate BMD?

[ROSModerator Partner]

Thank you for your post. We've noticed no one has responded to your post. Do take a look at this section on our website theros.org.uk/information-a... If you'd like to talk this through you can always contact our Specialist Nurse Helpline theros.org.uk/information-a.... Best Wishes, ROS Moderator

[Met00]

It looks like lateral spine bone density focuses on loss of trabecular bone: "A lateral spine view is a more sensitive tool in assessing bone loss in trabecular bone." (ard.bmj.com/content/80/Supp.... I don't know whether it's the same as a Trabecular Bone Score (TBS), but if it is, TBS is meant to give a better indication of bone strength than regular t-scores.

[FearFracture in reply to Met00]

Last weekend, I had an REMS scan. My REMS t-scores still show osteoporosis but are much higher than my DEXA t-scores. Additionally, according to the REMS scan, the bone quality of my lumbar spine and hips are both in the green—the doctor said my bone quality was excellent. He also mentioned that according to WHO, if there is more than 1 standard deviation between any two T-scores on a DEXA that the patient should be sent for further testing (to rule out cancer or something else) or that the DEXA is “faulty”. This is the first time I’ve ever heard this.

[Met00 in reply to FearFracture]

I've had 3 REMS scans, which I trust more than DEXA because it's more automated so less open to error. My last DEXA scan gave me a hip score of -2.5, spine -3.6, whereas my first REMS, 15 months later, gave both hip and spine as -2.6. The only problem is that REMS scans aren't officially recognised by the NHS, so it depends on your own doctor, whether or not they accept the results. I've no idea whether mine does - I've sent them all to him, but never had a response! He hasn't, however, sent me for another DEXA, now nearly 6 years since my last one.

[ROSModerator Partner]

Thanks everyone for your comments in this discussion about REMS, we can see that everyone is giving each other a lot of support which is great.

We’ve noticed that some people have been saying that REMs is more reliable than DXA scanning and is the best test to understand your bone strength. The current up to date expert-view, based on the research evidence, is that REMs is an interesting scanning method which is currently being researched. But it is not yet accepted by experts in the field of bone measurement as a reliable and fully tested approach to understand how strong your bones are.

We have a video and web page here which gives more detailed information about this topic. Please see the ultrasound information on the ROS website theros.org.uk/information-a.... You can hear more from an expert youtube.com/watch?v=YS9Raxh...(Not working as expected?) (30.15) . The scans and tests section of our website tells you the best ways to investigate and understand bone strength.

This can be a tricky area to understand because no scan or test can perfectly explain bone strength and we all want a definite answer especially if we are making decisions about medications. But just a reminder, please do not post anything as ‘fact’ when it’s a personal view and not yet proven as it can be confusing.

[Kaarina in reply to ROSModerator]

I am most appreciative to have learned about rems on this help forum. I have scoliosis so the dexa scans could never provide me with any results on my spine. That is no use to me. The rems does provide me with that information and I will be forever grateful to have learned about it here. I made my own enquiries to ask if this was possible with a rems and was told if the scoliosis was not too severe and he was willing to give it a go three times in a session to see. I took him up on that and got results. Will be having my third rems next year.