Difference between my Dexa scan and REMS scan

[Lopera]

I thought it would be interesting to share my scan results.

I have 6 spinal fractures discovered after an MRI in October 2024. I then had a Dexa scan with the following results:

Spine -2.8 Osteoporosis

Hip - 0.5 Normal

As there is major discordance here and as I am about to start on Teriparatide I have recently had a REMS scan as I wasn't happy with the above as a baseline against which to measure any improvement.

My REMS scan results were quite surprising to me.

Spine - 1.8 Osteopenia

Right femur - 1.9 Osteopenia

Left femur -1.9 Osteopenia

Had I had a scan with these results before any breakages, I would have assumed I was 'safe' and just needed to pay attention to supplements and more exercise.

I asked about taking strontium citrate as there seems to be controversy here and the answer was that there have been no trials to establish whether it makes bones stronger and the jury is out. I think he said the bones can become denser but this didn't equate to more strength. I recorded the whole appointment but have managed to lose it.

One unwelcome result having lost 5 inches is that I am now officially obese according to BMI calculations! I need to work on that!

[Rooruby]

That is quite strange regarding REMS scan. Can I ask how you fractured your spine. I have severe osteoporosis t score -4.5 and suffered t12 fracture Sept 2023 that is progressively worse Jan 2024. I started teriparatide Nov 24 and they will next dexa scan 2 years so I paid and booked REMS scan for this October to see how things are going. I only coughed gently and fractured spine. I don't understand how you only show Osteopenia if you have had numerous fractures.As for supplements I only take vitd3 daily 1000. I hadn't stop Adcal calcuim as I have high cholesterol and now have to get calcuim through diet which is very hard when you have high cholesterol lol it's a minefield

[Lopera in reply to Rooruby]

I didn't know I had fractures. I went to the GP in 2023 with severe back pain which I felt had come out of nowhere. I didn't recall doing anything to warrant the pain. The GP recommended physiotherapy and painkillers and after about 3 months it went away. A year later I went back to the GP in about April 2024 with the same thing again and was recommended to try physio. I wasn't getting better and by summer I couldn't hold myself up so had a private MRI which revealed 6 fractures and I was told three were old so happened in 2023 and the other 3 in 2024.

It was explained to me that the bones are weaker and once one goes, the biomechanics of the spine mean you are highly likely to have more.

I've never had my cholesterol measured and didn't know there was a relationship between calcium and cholesterol. I agree it's difficult to get enough calcium in through diet. I take the Naturelo bone health supplement plus collagen powder.

[Lilbil in reply to Lopera]

Hi my first dexa scan back in 2018 after a fall and 2 fractured vertebrae showed osteopenia and my GP started me on Vitamin D, then in 2022 I had severe back pain after 3 visits to A&E they did a CT scan of my spine which showed a fracture of T10 vertebra so was sent to a spinal clinic and after a further X-ray which showed I have 7 old fractured vertebrae a further dexa scan still only showed osteopenia. I was then referred to the osteoporosis consultant, who said my bones were in a terrible state and was put on 2 years of Teriparatide my bones improved by 17.5% I asked the consultant why the dexa scan never showed osteoporosis, he said they are only a guide and all the scans and X-rays need looking at as a hole not just on there own. I’m now on 3 years of Zoledronate infusions before my next dexa scan. I think the scans alone can give a confused picture.

[uncountable3 in reply to Rooruby]

Independent on the scanning method, it is entirely possible to have osteoporosis even with normal density bones. Sufficiently poor bone quality/architecture is enough to weaken bones enough. TBS and REMS fragility score might shed some light on this but they may not. TBS, at least does not correlate well in these cases.

[Lopera]

I think I must be your shadow. I'm about to start 2 years on Teriparatide then Zolendronate infusions. I hope I have as good an improvement as you did.

[Lilbil in reply to Lopera]

Hi Lopera I would have been happy to stay on the Teriparatide as I had no side effect and it was easy to inject, but they only recommend 2 years. I hope your treatment helps you improve and get stronger

[Lopera in reply to Lilbil]

I wonder if the two year recommendation is because of the price or whether there is a clinical reason.

[Fruitandnutcase]

I’m no medical expert but regardless of anything else I imagine having lost 5” in height means you probably do have osteoporosis even if your DEXA scan says ‘hip- normal’ and your REMS says osteopenia. Five inches is a lot of height to lose. Hope your future treatment works out well for you.

I looked into strontium citrate when I was first diagnosed but decided the contraindications were too risky for me besides I think as you said your bones can become denser but not necessarily stronger.

[Lopera in reply to Fruitandnutcase]

Yes this is what I was told. Regardless of the scan result, the fact that I have fractures mean I am treated for osteoporosis. I've also decided strontium is not for me. I want my bones to get stronger not denser.

[Verauk]

Lopera hello, Have you discussed with your Doc these discrepancies between REMS and DEXA results? How can we explain such a huge diferences? Thanks a lot

[Lopera in reply to Verauk]

I haven't discussed these results with my GP. He sent me for osteopathy when my upper body had clearly slumped. He even commented on my slumped posture and I still wince at the memory. I don't really have any confidence in his knowledge of osteoporosis.

I recorded my session when I had the REMS scan but although I thought I had saved it to play back later, I have lost it. Basically from memory, he said when there is major discordance it should be looked at as it is generally a mistake. Also that osteopenia does not preclude bone fractures.

[Mongoose59]

Hi Lopera

That is interesting as there is a big difference between the two methods. I did pick up that with DEXA you must be adequately hydrated, what ever adequately means. I think it’s quite possible to not have had enough water if waiting around for a DEXA scan and the journey to the hospital. As you say REMS does assess Bone quality although following a DEXA scan the Rheumatologist did tell me that bone turnover was good so I guess that’s and indicator that I’m not building up dense dead bone. I certainly would like a REMS scan though.

The point you make about height change and BMI makes you think. I was at my yearly health check and was told I was over weight because of a BMI reading. I mentioned that before I lost 2” height I was not over weight and that I weighed the same how come? No answer was given but now my notes say ‘must expect height loss with age’ ??? Don’t get that. Also you need a bit of weight to help promote bone growth. And there are other measures such as waist to hip ratio and machine to measure visceral fat content, if you can find a weight machine that does that.

Going back to the DEXA FRAX mismatch, I think this is quite a big issue as which one is right and therefore could drive someone down the bisphosphonate route unnecessarily.

[Lopera in reply to Mongoose59]

It will be interesting when I get another DEXA scan after 2 years on teriparatide which I am about to begin. I will repeat the REMS scan in 1 year.

The waist to hip ratio I don't think would give a great result for me as my waist has disappeared along with the 5 inches! I used to have an hourglass shape. I wouldn't like to describe it now.

I don't know the answer to the bisphosphonate route and I think it's a question of your attitude to risk. The trouble is you have no idea how debilitating spinal fractures are until you have them.

Many people just look at the potential side effects but as my glass overflowing husband pointed out to me when I was reading out the possible side effects of teriparatide, I was only looking on the pessimistic side.

Joint pain 10 in 100 (8 in the placebo) group etc. I only saw the 10 in 100!

[Mongoose59 in reply to Lopera]

How did you get a REMS? Was it NHS?

[Lopera in reply to Mongoose59]

I paid for it privately.

[Mongoose59]

Yes I will not forget the pain I was in with 3 crush fractures and that is very important not to forget. I took the Ibandronic acid gladly and with vit D and calcium things improved.

[Fatpidgeon]

Hi Lopera,

I am sorry you have such conflicting results, one or both of the reports are probably wrong. As you paid for the REMS scan perhaps you could ask if the report could be reverified because it is so discordant with the DEXA scan.

From my own personal experience I can say different scanning technologies tell different stories about the same problem. In my case it was a benign Kidney tumour, the size of which differed between the different technologies.

I would stick to the same technology when assessing progress of treatments.

[Lopera]

He did both hips and spine twice while I was there. I shall have another REMS scan in a year and the DEXA whenever I'm called forward for it. I'm interested to see the results with both.