Different DXA and REMS Results

[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.

[Starsearcher]

Hi Knitterbox

I am guessing you saw Dr Nick Birch in the UK? I'm curious as to why you had the DEXA scan at 56 years of age as in the UK we are not offered one until we break a bone over 60 probably.

I broke my shoulder in 2020 and then went for the DEXA scan where they diagnosed osteopenia in my spine. My GP recommended Alendronic Acid as per their guidelines. I did my research and declined. I found this website of great value - it's American and goes through the history of the "disease" and the drug history. It'll make you mad!

saveourbones.com/

I subsequently improved my diet, took supplements, did an exercise programme and invested in a Marodyne Liv machine.

Then I went in June to see Dr Birch.... the results aren't always easy to understand but I went on what he verbally told me - I had an excellent set of results (for my age) and didn't need the drug and to stay away from any conversation with my GP and advised me "not to let myself get frail". I'm 67. From what I can understand my REMS scan is different from my DEXA one but he is pretty sure that my DEXA scan results were inaccurate and now I need to go back to him in 2 years time to compare like for like and to see if what I am doing is enough for me. By standard measurements I have osteopenia in my hips and spine (the DEXA scan said spine only) but I still don't need the drug. I suppose this is because practically every woman of my age has osteopenia and it is a natural thing to happen and bone density has nothing to do with whether you break a bone. He also told me that there is evidence to suggest that 90% of DEXA scans are inaccurate.

pubmed.ncbi.nlm.nih.gov/347...

I think there are quite a few article like the one above re DEXA and REMS accuracy.

If you are only 56 and already on the drug which I believe you should only take for 5 years then what will you do after that? You are in an ideal position to build up your bone strength at an early age naturally! The drug messes with your body's ecosystem and incredibly complex bone chemistry. The arrogance of the medical profession dumbfounds me (and I'm a nurse and midwife) Honestly, once you research about this issue - how Big Pharma has made a disease out of a natural process - you will be horrified and angry like me!

Good luck with everything!

[Seasid in reply to Starsearcher]

I believe you could be on Prolia for 10 years. I agree with you not to take injections of 60 mg of denosumab (prolia) lightly without good reason and without doing some exercise first. And finding out the real cause of the bone loss.

Could you please explain me better what did you mean that bone density score is nothing to do the probability of bone fracture? I would like to understand that better as on my results they stated the probability of bone fracture in a next 5 years and 10 years. Therefore I believe they must have a database of that. (Maybe they collected the incidence of bone fracture of the individual in correlation with the bone density score from the DEXA scan?

I would like to know more if that fracture probability is derived from a real world data or somehow else?

[Starsearcher in reply to Seasid]

Hi Seasidncbi.nlm.nih.gov/pmc/articl....

This is a bit difficult to explain! You have to come to your own conclusions really. It was something the REMS consultant threw in - your chances of breaking a bone are due to so much more than bone density alone which seems to be what the medical establishment mainly goes on. It depends on your balance, fraility etc etc too.

[Seasid in reply to Starsearcher]

Agree

[AnnieW55 in reply to Seasid]

DEXA scans measure bone density and fracture risk is worked out by getting a FRAX score (you can Google FRAX to work out your score as long as you know your numbers). As you get older your FRAX score does worsen, it’s built into the algorithm, by the time someone is in their 80’s the figure doesn’t change as it is expected that person will be dead f something or other by then - charming! Don’t forget, if you are told you have a 20% chance of fracturing in the next 10 years that means you have an 80% chance of not fracturing.

DEXA gives bone density (your T score) but REMS being an ultrasound tool also gives bone strength and that is important - someone can have low density but good strength which is reassuring. Strong bones = less likelihood of fractures. DEXA is also reliant on technicians being well trained and making sure placement is absolutely correct. If someone cannot lie flat, or has arthritis, their results can be skewed.

I’m in the UK have had both DEXA’s and REMS scans and prefer the REMS as they give more information and the results more consistent between spine, neck of femur and total hip. Osteo scan here in the UK is run by a spinal consultant surgeon and he actually performs the scans himself which is reassuring.

[Seasid in reply to AnnieW55]

Thanks, very interesting.

[Knitterbox in reply to Starsearcher]

thank you for the advice. I broke my arm in a fall in February which was caused by a dog attack so was fairly traumatic and resulted in me literally being knocked off both feet. I asked for the DXA because the orthopedic doc recommended it.

I’ve held off taking meds and just increased weight bearing exercise, calcium and appropriate supplements based on advice in Dr. McCormicks book Great Bones. Considering HRT as I’m still quite young. It’s just that the REMS result made me question being on medication at all at this age.

I actually had the REMS scan done at profortis sports therapy in Amersham which is another echo light REMS provider mentioned on this site.

[TWEETYCAT in reply to Starsearcher]

what did your DEXA scan show as your numbers, if you would not mind sharing?

[Starsearcher in reply to TWEETYCAT]

Hi TweetycatAP spine -2.1 left hip -0.8 DEXA

[Starsearcher]

npr.org/2009/12/21/12160981...

Another member sent me this recently in response to a question about travel insurance (you have to declare osteopenia when you buy insurance)

[Seasid in reply to Starsearcher]

Wow

[Zillogirl]

I’m 57 and I’m going for an echolight scan in January in North Carolina. I actually spoke with the nurse there just yesterday to make the appointment. She told me if DXA is completed accurately the results of the echolight and DXA would be similar. For you to have such different readings would mean someone didn’t perform or read the scans accurately. I’d personally be concerned about such a large discrepancy. One way to check would be to go again in the states to an accredited facility to have the DXA performed again. I’m having the echolight and a new DXA on the same day in NC. I live in SC and we have no accredited facilities for the DXA. I want to get a baseline before my doc prescribes Fosteum plus, because I’m trying to avoid the meds for now at my age

[Knitterbox in reply to Zillogirl]

Thanks for your reply! We are the same age so managing this condition at the same stage in our lives. I did think I should go get another DXA. What do you mean by “accredited” facility? I thought all DXA facilities in hospitals were accredited….

[peggykd in reply to Zillogirl]

Hi. I live in North Carolina and have been trying to find a REMS scan. Where did you get yours please. I live in Hendersonville

[Zillogirl in reply to peggykd]

It's scheduled here: centralcarolinaortho.com/. So, a long drive for you for sure. Out of pocket cost is $650, if your insurance does not cover it. You have to pay for before and after consult, in addition to the scan. So, the $650 includes scan and two consults.

[HealthELiving in reply to Zillogirl]

I have an upcoming appt for an echolight scan in NCas well - I am suspicious of the Dexa results I received and non-medical (PCP) help. Where in NC will you be having your DXA - I would like to find a reliable location. The one in SC was from a hospital... you would think... but a notation on the scan indicated that the leg may not have been properly positioned!

[Zillogirl in reply to HealthELiving]

Wake Radiology. They were recommended by my doctor in SC (new to our area) who is focusing on bone health. They have several locations.

wakerad.com/

[osteo2021]

Hi Knitterbox. Yes, my DEXA and REMS scores were very different. Are you small boned? Research indicates that DEXA scores are not as accurate for smaller boned people. Although not many, there are some facilities that offer REMS scans in the US. If you search this site for “REMS” you will find several helpful discussions and useful research. Personally, I trust REMS over DEXA.

[Knitterbox in reply to osteo2021]

Thanks for the reply. I am tall so don’t think of myself as small boned and I’m a normal weight so probably not actually small boned. I was told that it’s really hard to get a “wrong “ reading with REMS because the machine won’t give a reading unless the equipment is properly positioned.

[Zillogirl in reply to osteo2021]

This is another reason I want the REMS / Echolight! I was pretty thin most of my life 5'6.5" and around 130-135 pounds most of my life. This makes me both more susceptible to osteoporosis, and also suspicious of scans, because I do have smaller bones.

[yogalibrarian]

DXA and REMS are totally different. They don't calculate the same way so you really can't easily compare them. (A skilled clinician can make some useful comparisons that are impossible for the layperson/patient.)

Note: you cannot easily make comparisons between DXA scans from two different manufacturers either.