My OsteoStrong salon is offering a new test called Echolight. I believe it's a type of ultrasound that shows you more about your bone health than DEXA reports. It displays information about not only the outer bone, but the inner bone as well. It is not super expensive $150-200.
Does anyone have experience with this test?
It's a REMS ultrasound scan, which is available privately at a number of locations in the UK. I've had 3 and trust them far more than DEXA, so long as the operative is fully trained. They're more fully automated than DEXA, so less open to error, plus they give an estimate of bone strength as well as bone density, which is far more relevant than density alone. There were errors in the spine measurements for both my DEXA scans, which resulted in an osteoporosis diagnosis (well into the range) even though my hip scores were only osteopenic. This difference didn't exist between my scores from a REMS scan a year after my last DEXA, with similar scores for both, by then just into the osteoporosis range
What is your favorite document or resource that explains the REMS test in detail, showing evidence for its ability to measure what it claims to measure, and so on? Perhaps also comparing to DEXA. I would like to do a deep dive into both technologies. Thank you for being awesome. 
How about this: ncbi.nlm.nih.gov/pmc/articl.... It states "The literature data confirmed diagnostic concordance between BMD values obtained using DXA and REMS. Furthermore, REMS has adequate precision and repeatability characteristics, is able to predict the risk of fragility fractures, and may be able to overcome some of the limitations of DXA." Also ard.bmj.com/content/80/Supp..., which states: "Conclusion: The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility."
One thing I am struggling with is how on the one hand REMS has been said to have confirmed, strong concordance with DXA, yet there is little to no correlation between the Fragility Score of REMS and the T-scores of both technologies. It’s fascinating to try to unravel.
They omitted all the erroneous results for each and compared accurate ones. With those they found that REMS and DEXA give similar results. Unfortunately in general practice errors seem to occur far more often with DEXA than with REMS. As far as the fragility score is concerned, it's already known that bone density (reflected by t-scores) doesn't give a reliable indication of bone strength, which is why some people have fragility fractures with osteopenia or even with normal bone density, while others with very poor bone density never fracture. One of the things that shouts out to me that there must be an issue with DEXA scans is that you can't compare results from two different machines. If two machines give different results, they can't both be right!
I see one cross-sectional study (see link below) with a decent sample size (n = 1914) that shows:
“In the spinal group, quality assessment on medical reports produced the exclusion of 280 patients because of REMS errors and 78 patients because of DXA errors, whereas 296 DXA reports were re-analyzed and corrected. Analogously, in the femoral group there were 205 exclusions for REMS errors, 59 exclusions for DXA errors, and 217 re-analyzed DXA reports.”
link.springer.com/article/1...
As you have noted elsewhere, operator training is obviously critical in reducing these types of errors for both technologies. But even with operator training, these types of errors seem to occur in both cases. I don’t see a vast gulf between the technologies above. You did say “in general practice,” but even in a study environment these error rates are not negligible. I still need to locate and review the one article which suggests a 90% error rate in DXA.
When you add back in the re-analysed DEXA results, that's significantly more errors than in DEXA than in REMS, though as you say, that's still a high rate of error for both. I'm fortunate to go to a consultant who is extremely meticulous in ensuring that REMS errors are avoided. The machine itself won't allow alignment errors because automation prevents this, and it's able to get accurate readings where there's spinal scoliosis because the machine is lined up with each vertebra independently rather than your back having to be lined up straight for the DEXA scanner that has a fixed movement. It's also possible to compare results from different REMS machines (small margin of error), whereas that isn't possible with DEXA scans (larger margin of error).
Your question about comparability between different DEXA machines is exactly what I asked my PCP when she said that she didn’t want to see my previous DEXA results which had been done at a different healthcare facility. I asked how would we know which DEXA result was accurate when there is so much variability? She gave me a vague response that indicated the DEXA machines at her facility were very accurate. ??
I live in California and so far I have not been able to find any REMS Echolight machines in California. I am thinking about flying to have the REMS test done at one of the Echolight Machines on the East Coast.
I hear you! I am currently living in Berlin, Germany and will have to take the train all the way South to an expensive private clinic, the only one in all of Germany offering REMS. May as well fly home to the U.S. or take a trip to the U.K. I would love to hear of any results if you get the REMS and how they compare to your DEXA. I have my next DEXA scan (four different machine used up to now) in May.
I know I have found people in Portland OR that offer the scans. I have not used them myself, so have no idea who is better or worse in their readings, but Portland is an easier trip than the East coast.
Hi, I had the REMS test done in Dallas, Texas, last year and am very glad for the great detail the test results provided. Someone said that the DEXA test, in providing info on bone density, can tell you that the "dining room table" of your bones is missing a few legs. The REMS test gives you additional information about the bone quality, that is, it can tell you whether the legs on that dining room table are made of carboard, of solid wood or something in between. I like this analogy.
Below is the text of my posting about my REMS test from a couple of months ago. The YouTube video I refer to below, I found, was very informative and helpful.
Best wishes in your research on the REMS test.
This week I got a relatively new bone health test called the Echolight REMS scan. It is found to be more reliable than DEXA scans and gives information not only on bone density but also on bone quality/fragility. Unfortunately this scan is not covered by insurance and is not widely available but it may be worthwhile if you can find a place that does the test and if you can afford it. You receive a detailed printout of your results about 10 minutes after the scan is done. I got mine done in Dallas, Texas, and it cost me $150. It is recommended that you get one every year to be able to track your progress.
As I mentioned above, the scan measures not only bone density, as the DEXA does, but also bone quality/fragility. This information was very enlightening to me. Be sure to ask the technician to measure bone quality/fragility if you get a REMS scan. Most technicians should know to do so but be sure to ask.
The DEXA and the REMS bone density measures are not actually comparable. Also, the DEXA results can vary from machine to machine as well as from one technician to the next. The REMS scan is felt to avoid these 2 drawbacks. A European study cited in the video linked below found that 90% of DEXA scans had some error, and 50% of the scans had significant errors. Also in the video linked below, at the time stamp of about 2:30, Dr. Brown tells the story of a woman who was "terrorized" by her DEXA results for 13 years. Then she got a REMS scan and found she had fine bone health and very little risk of fracture. This woman states that the REMS data was "life changing." At the end of the video below Dr. Brown also talks about the negative effects that stress and fear have been found to have on bone health and mentions the benefit of happiness on bone health. I love her positive, holistic approach.😄
You can go to YouTube and put this in the search box to fine the video I found helpful.
NEW OSTEOPOROSIS TECHNOLOGY: Understanding Your REMS Report for Future Stronger Bones
You can also try the link below to get the video directly. I enthusiastically recommend getting this scan if you can do so.
youtube.com/watch?v=v0tclg8...
Also, you may want to check out Dr. Brown's website:
betterbones.com/
I hope this is helpful.
Jim
Thank you!
Thank you for the good information and links to articles
You're welcome
exactly what Met00 said. REMS is not new. The standard DEXA needs to be replaced but politics are in the way.
Thanks!
I just did the Echolight and it soooo much more accurate, my T scores are better and not walking in egg shells anymore, still have some work to do but my L4 went from a -3.4 to a -2.5, still Osteo but the “oh shoot what if” factor has lightened up significantly. It also see throu things that can make the dexa look worse was the explanation I got on the different scores, my Dexa was September 23 and the Echolight last week Jan 24
I just had my REMS done here in Chicago area in the U.S. The results are T score and z score (similar to DEXA) but also a fragility score. I am characterized as osteopenia with this (as opposed to osteoporosis with DEXA) and established I have strong bone quality (fragility scores) . This was worth $250 out of pocket for the test (doctor visit was paid for by insurance).
Oh my gosh, so worth it, I will be driving to Dallas for my Echolight every 6 -9 months to track my progress, it’s a blessing for all of us that this is now available. It’s wonderful not living in fear anymore ♥️
Thank you for the info- I am still osteopenic on DEXA and my scores have all improved since doing the OsteoStrong program. I'm encouraged to go ahead and pay for the REMS to see the difference in what it reports.
Hi - where in Chicago?
I am in Grand Rapids, Michigan and drove to Windsor. Chicago is closer.
Thank you!
The Sports Medicine and Regenerative Therapeutics Institute in Hinsdale, IL
Thank you!
Thank you!
I am so happy for you! Please help me see how you are convinced one is much more accurate for you than the other. How do you know what the true status of your bones is to know which is the accurate one? I want to trust this thing but need to understand it better.
I am not a medical provider, but it was explained to me like this, there are several things that can show up on the dexa and cause dark spots which it can read as a hollow space. These will make your score higher on the negative end. The Echolight is an Ultrasound and it can see through all of the things can show up on the Dexa. In my case my Dexa showed -3.4 on my L4 in September of 23, the Echolight showed -2.5, the difference in such a short time just baffled me, the only things I am doing is the Osteostrong and the AlgeaCal/Strontium combo.
Dr Doug Lucas has a video about it on his YouTube Channel and he is a firm believer in it and recommends it for all of his patients. I would recommend following him at Optimum Bone Health on You Tube fantastic information.
I hope this helps.
I, too have had a similar response with OsteoStrong. I have not yet made the switch to AlgaeCal, but do take another Calcium/K2/D3 supplement. I have found Dr. soug Lucas to be a wealth of info! Thanks for the extra info on the REMS!
Careful with AlgaeCal, strontium appears as high bone density on a DEXA but it’s false density. Read some articles about it first.
Thank you for the warning. The whole calcium thing is frustrating!
Sure, it really can be frustrating. I have osteoporosis but haven't taken calcium supplements for years. I'm seeking instead to get sufficient calcium in my food, and I seem to be succeeding. My calcium levels in my blood tests in the past year have been in the normal range. I understand that your body can't absorb more than 500 mg of calcium at a time so I try to eat a few small snacks during the day that contain about 500 mg of calcium or less. One and a half cups of milk has about 500 mg of calcium, so I try to drink that much milk about 3 times a day. A 4 1/2 ounce can of sardines has about 420 mg of calcium. I hope this helps.
I think blood calcium levels are not indicative of what your bones are like as the bones will release calcium into the blood to maintain all the other things which calcium is needed for.
You are right that food is the best way to get calcium. But you also need several micronutrients to make sure the bones actually receive that calcium, notably Vitamin K2 and magnesium, and a few others (e.g. boron). Vitamin D enables the body to absorb calcium but it doesn't tell the calcium where it should go - Vitamin K2 and magnesium do that work.
Somehow I missed the message on importance of magnesium. Due to acid reflux, I’m taking 400 mg per day and it’s important to take the highly absorbable form chelate glycinate per my doctor- just started taking magnesium this week.
I am another person wanting to to tell everyone about Dr. Doug Lucas. I think he is the top resource for all things bone health. He and his team recommend REMS Echolight and his YouTube video on it and DEXA is a myst see.
I'm in the UK and am having one next month. Paying for it as it's not available on the NHS ( as someone says politics.) I have a diagnosis of severe spinal osteoporosis but no breaks( I keep bouncing! ) or loss of height. I'm looking forward to my REMS whatever the outcome. Money well spent...
Yes, my insurance will not cover it either. Thanks.
Hello, I am looking to book one in the south of England too. I have found one clinic in Northampton. My T score was again -3.1 in July on Dexa scan while spine shows osteopenic-2.3 . Under medication and should be better by now.
I had one done about 18 months ago. The results were different than my DEXA scans. My spine had a better score, and my hips were slightly worse with the Echo test. The opposite of the DEXA results. The Echo doctor explained the DEXA score was lower because I had a laminectomy on my back, therefore less bone and the DEXA reads amount of bone, the Echo uses different (ultrasound) technology. My Echo fragility score was good in the green, despite being diagnosed with osteoporosis with DEXA. This gave me some piece of mind and made the Echo worth it. I felt I wouldn’t fracture so easily as I thought previously. All in all, I still decided on taking Forteo. My logic was since my density wasn’t going to get any better as I age and since my DEXA score of —2.9 wasn’t terrible, it was a chance to go back to osteopenia or even normal bone density with the drug. I’ve been on Forteo almost a year and my blood bone tests look good. I’m anxious to see my next DEXA in May. Some mild side effects from the med for the first 2 weeks, then my body adjusted. BTW, my Echo was $60. I see the price is going up as it reaches more popularity.
Actually it is possible to improve bone density, even when older. I did so in the year between being 68 and 69 (had DXA scans both years. Haven't had another scan but feel that as I continue to do what I did that year (or most of it anyway, details change) I'm hopefully okay for the rest of my life. Am now 76.
healthunlocked.com/pmrgcauk...
That’s great! If you can do it without meds all the better. My friend did it with careful weight lifting under the supervision of a trainer.
Just be careful if using strontium. Studies of the strontium determined that as much as 50-75% of BMD increase isn’t actually an increase in density of bone. Strontium makes it seem as though there is more bone than there actually is.
thank you! Yes, I will be paying $150-199. In Idaho
Yes! At age 65 I had my first DEXA scan showing osteopenia & beginning Osteoporosis. As a recently retired Dental Hygienist, if patients were recently prescribed Bisphophonates, I always encouraged my patients to further research and discuss more thoroughly with their prescribing physician their individual risk to benefit ratio. So when I received my initial DEXA results, that is what I did; research!!!
In fall of 2021 I planned on visiting our daughter in Texas (I live in Washington Staye) so I called ahead to schedule an Echolight scan. This was the closest most Wedtern scan location at the time. I paid out of pocket ($200) & went ahead scheduled my 38 year old daughter for one, too. They gave us written reports showing no osteoporosis but some areas of Osteopenia for myself & normal values for my daughter. This way she has a baseline for future comparisons. This scan doesn’t just evaluate the density of the bone (as DEXA), but also the STRENGTH of the bone structures. It does not use radiation but sound waves, so is less invasive and also less variables are present, so the results are reproducible. Even though the “Gold Standard of “recognized” testing is still the DEXA, the Echolight scan seems to be gaining favor among clinicians.
Mayo Clinic has a site you can make & reply to comments about dealing with osteoporosis. God Bless!
Haha! I am also a retired RDH- well, I'm retired from private practice. I still serve as an examiner for CDCA-WREB-CITA. I shared your desire to avoid the bisphosphonates if at all possible. Now you can come to Boise for your future scans (and there may be sites is WA by now). Thanks for the reply!
I just had the REMS ultrasound in the office of Dr. Andy Bush in North Carolina. He was the only one who looked at my DEXA scan and saw deficiencies in the image. First there was more than a standard deviation between the lowest/highest scores. As Keith McCormick advises in his book Great Bones, you throw out the lowest score in that case. Dr. Bush also noted that the L4 and L5 were rotated. No other doctor had noted that. I went from a DX of severe osteoporosis with the DEXA scan to osteopenia with the REMS. Dr. Bush also advised if I ever do DEXA again, do it only with a machine equipped for TBS (trabecular bone software). If you can't access REMS or TBS, you may want to do a phone consult with McCormick. I feel confident he would have seen the problems with my DEXA scan, which would have relieved my mind. With seeing Dr. Bush, I had a scan option other than DEXA. Here is a link to an interview with Dr. Bush explaining REMS:video.search.yahoo.com/yhs/...
Thank you! I feel so fortunate to have this available in my home town!
You are lucky! I had to drive 3 hours one way
How do you find a practitioner that uses Echolight/REMS??
Best I can find is lemtradarems.com. Be sure to enter your zip code up top. Their list of practitioners is not done alphabetically by state.
QCT I understand shows fragility.. the inside of the bone… quantitative CT a tomography test …still trying to locate someone who will do it.. going to check with Endocrinologist
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