I got a REMS scan; here’s what I learned.
Back in February, I interviewed orthopaedic surgeon Dr Nick Birch on what’s wrong with the current medical approach to bone health, and how to fix it. We spent a good chunk of our conversation discussing Radiofrequency Echographic Multi Spectrometry (REMS), a technology which not only measures bone density, but more importantly, the degree of fragility of bones. It’s this ability to assess bone fragility which makes REMS a far more accurate predictor of fracture risk than DXA, the current standard of care. And REMS, being ultrasound-based, involves no exposure to ionising radiation, unlike DXA.
You can watch (or rewatch) my interview with Nick here:
After speaking with Nick, I was intrigued to see what my own REMS scan results would be. On the one hand, I’m postmenopausal and have a family history of osteoporotic fractures, both of which are risk factors for having such a fracture myself. On the other hand, I’ve been weight training for years, and weight training reduces the risk of fracture (as Nick mentioned in our interview). Unfortunately for me, there aren’t that many facilities offering REMS in Australia and the rural area in which I live is particularly poorly served, so it wasn’t until a recent trip to Sydney that I was able to tee up an appointment for a scan.
A REMS scan takes less than half an hour and is noninvasive and perfectly comfortable; you don’t even have to undress. Both the left and right femoral necks (the narrow bridge of bone involved in a so-called hip fracture) are scanned, and the lumbar spine is scanned via the abdomen, using a hand-held ultrasound probe.
Your results are instantly available to discuss with the sonographer, and you’ll then be sent a report which is, to put it mildly, extremely comprehensive. This walk-through of a REMS report will give you an insight into the insights that you can gain from REMS:
Although, as mentioned above, REMS assesses bone mineral density with accuracy comparable to DXA, what I was really interested in was the fragility score. And, as Nick stressed, bone mineral density and fragility score can be discordant – that is, your BMD can be low (which is conventionally considered to indicate elevated fracture risk) but your fragility score is low (which definitively indicates low fracture risk), or vice versa.
In my case, my bone mineral density was on the lower side, in the range that’s classified as osteopenia, the precursor to osteoporosis (but see my article The great osteoporosis scam for a detailed discussion of the problems with this classification system) however my fragility score was also low.
The sonographer explained that the fragility scale goes from 1-100, with anything below 30 considered low risk for fracture, and in practice she never sees a fragility score below 10. So I was chuffed to see that my left and right femoral neck fragility scores were 16.3 and 16.4, respectively, meaning that my chances of suffering a hip fracture are negligible (4-8 osteoporotic hip fractures per 1000 people):
Looks like my leg days in the gym are paying off!
My spine BMD was also in the osteopenic range, but my fragility score of 23.5/100 was still comfortably below the fracture risk threshold of 30. Just to be on the safe side though, I’m going to be adding more resistance to my back exercises, and wearing a weighted vest regularly (as discussed with Nick during our interview).
If you’re interested in getting a REMS scan, check out Bone Compass or Osteosound for Australian locations, or just search for REMS + your city/region.
And finally, my REMS provider endorses the ONERO Program, a supervised exercise program that has been proven to assist with bone density and bone strength. It needs to be supervised by either a physiotherapist or an exercise physiologist. You can either locate an existing provider of the ONERO Program in your region, or get your usual physiotherapist or exercise physiologist to learn how to conduct the program for you by visiting the website and signing up to become an ONERO Program provider.
