REMS / Bone Health

Radiofrequency Echographic Multi Spectrometry (REMS)

Bone Health Status: What is REMS?

Healthy bones are a living part of your body, dense and strong. Their strength is affected by the foods you eat, your lifestyle, and your age, with bone density gradually decreasing as you get older

Bone densitometry assessment is an important decision point in the management of bone health status, documenting disease progression and monitoring any treatment effects (ie medications for example)

Despite the wide use of DEXA scans to produce bone mineral density (BMD) measurements as our standard method of measuring bone health status, it is insufficient to reliably evaluate the severity of the skeletal fragility and to predict the fracture risk of individuals. Common artifacts on the bones, such as osteophytes and vertebral fractures, often lead to inaccurate measures of BMD by DEXA technology.

What is REMS?

Radiofrequency Echographic Multi Spectrometry (REMS) is ground breaking, new technology that can monitor your bone status as you age. It provides convenience, accuracy, and is radiation free.

Clinically REMS provides the following important measures for your bone health status:

1. Bone Mineral Density (BMD): it is a quantitative measure of the amount of minerals (mostly calcium and phosphorous) contained in 1cm2 volume of bone.

2. T-score: Is the number of standard deviations (SDs) of the BMD above or below the mean BMD of young healthy adults (25-35 yrs, same sex & ethnicity).

Normal Bone: + 2.0 to – 1.0
Osteopenia: – 1.0 to – 2.4
Osteoporosis: > – 2.5

3. Z-score: is the number of SDs of the BMD above or below the mean BMD of the same age, sex, and ethnicity.

4. Fragility Score (FS): a qualitative measure which gives an estimate of skeletal quality and fragility of bone micro-architecture (ie. bone quality)

5. Fracture Risk calculation: an estimation of the patients Fracture risk within 5 years; derived by combining the patient’s bone density and Fragility scores. Please note the score is per 1,000 people (It is not a percentage).

6. Body Composition (Fat/Lean mass), Basal Metabolic Rate and other Activity Metabolism indices: Using the advanced software application within the Echolight device, accurate measurements are automatically provided after the scanning of the lumbar spine and bone assessment.

Fragility Score

Developed by Echolight Italy, the REMS device provides a newly developed diagnostic indicator, the Fragility Score (FS), to obtain an accurate bone health status by providing an estimate of skeletal fragility. This addition allows for:

The Fragility Score (FS) is independent of BMD and it is calculated from the proportion of ultrasound scan lines whose spectra are more correlated with a “fragile” (i.e. fractured) bone spectral model, than with a normal bone spectral model, using population based, anthropometrically matched reference models of ‘fragile’ and ‘non-fragile’ bones.

FS uses a scale of 0 to 100, and is in proportion to the degree of fragility, such that:

REMS Examination: How Is It Done

The patient was positioned supine and ultrasound gel was applied to the patient for the examination.

Femoral Neck Evaluation: The echographic transducer is placed parallel to the head-neck axis of the femur, to visualize the typical proximal femur profile. It sends soundwaves into the tissue and measures the ‘echo’ back into the transducer. After undergoing spectral analysis, the results were determined and the images reviewed. They were determined to be of acceptable quality for diagnostic purposes (i.e., left and right T scores are within 1 SD of each other).

Lumbar Spine Evaluation: The echographic transducer is placed in a trans-abdominal position under the sternum, to initially visualize L1 lumbar vertebra. As the examination continues, the probe is moved down to align with L2, L3 and finally L4. Upon completion, the images were reviewed, and they were determined to be of acceptable quality for diagnostic purposes (i.e., femur and lumbar spine T scores are within 1 SD of each other; L1 – to L4 should have increasing BMD).

References

REMS is a TGA approved, non-invasive, ‘radiation free’ medical device, used to assess bone health and microarchitecture. It uses advanced ultrasound technology to accurately measure bone mineral density, T-score, Z-score and provide a fragility score.

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