Can REMS scan be validated?

[uncountable3]

With DXA, it is possible to pass the raw data to a known expert (including the excellent dxaguru on Inspire) for review. These experts can pretty quickly determine if there is an issue and what the problem is. Has anyone gone through this with REMS? The results from my recent REMS are just too crazy to be trusted without further study. Are there any experts who can validate REMS results?

[Arcadia10]

Would you be willing to share your REMS results here? I had a REMS done in August 2024, five months after my DEXA scan of March, and my lumbar spine REMS results were quite different to my DEXA results. I posted them on Inspire.com and was told that you can't make a direct comparison between the two technologies, mainly because they use different reference databases.

I don't know if there is any way of validating REMS results. Perhaps pose the question for dxaguru on Inspire.com

[simpleguy999 in reply to Arcadia10]

Here's a link to another video that you may find helpful.

youtube.com/watch?v=6YYInYB...(Not working as expected?)

Also here is an image, sorry it's not clearer, of the my fragility score from my REMS. This is not something DEXA measures.

Fragility score from REMS test

[uncountable3 in reply to simpleguy999]

Actually, there is a DXA equivalent to the fragility score. It is called Trabecular bone score (TBS). Unfortunately, most providers, including the one I see, do not offer TBS.

[Arcadia10 in reply to simpleguy999]

Thanks for your replies and the links provided. I had actually watched both the videos a couple of months ago, but it was really useful to rewatch them and have my memory refreshed on certain points. Drs Doug Lucas, Andy Bush and Kimberly Zambito are obviously proponents of REMS technology, so the link provided by uncountable3 to the Bone Forte page which discusses the potential errors which can occur with REMS provides some balance.

I suppose that, in a few years' time, when a large enough number of people have had multiple REMS scans and seen consistency in results depending on treatment or otherwise, and particularly changes in their fragility scores, confidence in the reliability of REMS technology will increase. Also, until our regulatory authorities gain approval to have the scans partially covered by Medicare, I feel that there won't be much uptake and that it will be viewed as an alternative technology.

[uncountable3 in reply to Arcadia10]

Sure. This is mostly a cut and paste from my earlier post on Inspire. inspire.com/groups/bone-hea...

Relative to my December 2023 DXA, the REMS results are pretty radical. They show my spine "improved" from -2.8 to -1.4 (BMD + 22%)

Meanwhile Right Hip went from -1.4 to -2.3 ( BMD -15%)/

Left Hip was similar: -1.4 to -2.2 (BMD -14.5%)

This is a huge departure from four years of highly consistent DXAs from a top flight institution and reviewed by DXA experts. Even with my first year of Forteo I never saw a change bigger than 8% and definitely not spine and hip trending by huge margins in opposite directions. Further, my CTX and P1NP tests (one just before December DXA and two this year) do not suggest major movements.

On the last: Unfortunately, DXAGURU is not a REMS guru nor are any other DXA experts that I know. That is why I came here. There is more REMS traffic here, likely owing to the greater REMS penetration in the UK.

[Arcadia10 in reply to uncountable3]

I would also be sceptical with results like yours. It appears that something is seriously out of whack, be it technician error or machine limitations, as amarum says in her response on Inspire. I suppose the only way to check your results without input from someone on this site knowledgeable about REMS is to have a second scan after a period of time and see if they align. This was recommended to me by the operator of the REMS machine as my own scan returned some discordant results. Another possibility is to contact Nick Birch of Osteoscan UK directly and see if he knows if it's possible to validate REMS results.

My own results left me rather puzzled as my L2 and L3 showed significant "improvement" in the five months since my DEXA scan, while my left femoral neck which is regularly scanned by DEXA had deteriorated slightly. My right femoral neck, scanned for the first time by REMS, aligned in BMD with the left which was reassuring. Regarding my lumbar spine, as I have slight scoliosis I assume that the REMS is providing the more accurate result - but I want to avoid the temptation to assume the better result is the correct one. Like yours, my DEXA results over the past 12 years have been fairly consistent (apart from a rescan in March 2024 a week after my original scan which returned .3 SD diference in my total hip). Below are my lumbar spine results:

DEXA REMS

L1 -2.7 -2.8

L2 -2.7 -1.6

L3 -2.6 -1.7

L4 -1.5 -1.9

LS -2.4 -2.0

The operator was surprised by my LS results and actually scanned me twice before recommending a repeat scan in six months' time which is presumably to verify their validity. The fact that he was on a flying visit from Melbourne, Australia, to Perth to introduce REMS to a medical practice and a university and only had one day of scanning patients as part of a training course meant that I didn't get the chance to discuss my results at the appointment which was disappointing. I was also unsure whether he is the regular operator in the Melbourne clinic, so trained and skilled, as he is a research scientist on a promotional visit to Perth.

So I feel as confused as you. The fragility scores for each area were helpful though.

[simpleguy999]

Hi, I understand your experience. I got a DEXA and a REMS afterwards. The REMS results stated my bones were in a lot better shape than the DEXA. After watching the video linked below featuring 2 medical doctors who treat osteoporosis, I feel confident in relying on my REMS results. No test is flawless, of course, but the DEXA doesn't really provide reliability, according to the hard data cited in the video, and the reliability of the REMS results seem pretty impressive. I hope this helps. youtube.com/watch?v=v0tclg8...(Not working as expected?)

[Arcadia10 in reply to simpleguy999]

An interesting point made by Dr Andy Bush in this video is that the red line on the scan report images should be in the middle third of the screen. I noticed when reviewing my full report that the red lines for my lumbar spine vertebrae are more towards the lower third (26.24 in the video). I wonder if this could possibly be a cause for concern re accuracy of my results.

[uncountable3]

Consider less biased sources like this one. boneforte.com/keep-in-touch...

[Arcadia10 in reply to uncountable3]

That made for interesting reading, especially regarding the errors that can creep in when focal and depth settings are not appropriate. I recall hearing the operator of my scan discussing these setting briefly with the doctor who was in training. Hopefully they were applied correctly.

The bowel gas issue was also of some concern to me as I too have IBS, but this was not mentioned during my scan as being a problem.

[wellness1 in reply to uncountable3]

I'm a little confused, uncountable3. Bone Forte was founded in 2022 by Dr. Andy Bush, who is interviewed by Susan Brown in one of the linked videos. Have I misunderstood your point about 'less biased sources'?

Good luck getting more insight into your results.