Difference in scores between DEXA and REMS

Based upon my experience, I think those with osteoarthritis need to be cautious with their DEXA results.

DEXA
T scores are: L1-L4 = 2.5; L femoral neck = .5; L forearm = -3.1
REMS
T scores are: L1-L4 = -3.5; L femoral neck = -3.6

Looking at DEXA, both the spine and hip look great; however REMS shows a dramatically different story.

Same story here.
My DEXA scans consistently reported in the -1s for spine, which I was so pleased with since my hips were consistently in the -2.8 range. Then I get a REMS, which reported the same -2.8 range for my hips but -3.3 for my spine! What the DEXA had been measuring seems to be calcification, not bone density.
So, what to do. Some people may recognize my screen name as someone who has weighed in on my very lousy Tymlos experience. Endo has now recommended Evenity, but I'm too scared to try it. I feel great-- and am terrified I'll be one of the horror stories. Still taking Actonel, which does something for me, but not a whole lot.

Why do doctors order REMS versus DEXA? I’m only familiar with DEXA.

I had a bad experience with Tymlos as well but had to follow up with something post lumbar fusion. I’ve been on Evenity now for 7 mos and I’ve had minimal side effects . I’ve had some increased joint pain and at the beginning, occasional nausea and one instance of vertigo. With Tymlos similar side effects were much more frequent and more severe. A recent Dexa indicated significant improvement in my spine though some of that could be the bone growth material the surgeon added in. I’ve lowered my expectations with these meds.

Doctor did not order REMS-- I was curious about the new technology and paid out of pocket.

I had my first REMS performed November 2024 which was VERY different from my Dexa Scan in my spine. My REMS showed I was normal in my spine (-0.9) and osteopenia in my hips (-1.9). Since 2018, I have been considered stable with osteoporosis in my spine of -3.2 and -1.9 osteopenia in my hips. My prior Dexa scan was in April 2024.
I have had my scans at the same facility since 2018 and found a new facility that offers TBS along with the Dexa Scan. My new scan was performed 4/15/2025 and showed -3.2 in my spine and -2.0 in my hips. My TBS score was 1.185 which meant degraded microarchitecture. I was at least hoping the microarchitecture was a better score based on the REMS report, and do not understand such a difference.

I don’t have a lot of faith in the Dexa scan and so far have refused to take another one. I took one at age 51 and everything was in the green. I’m 74 now and with a not so great spine, however, I had a very successful hip transplant at age 72, no issues. I lost a tooth (old root canal tooth) last month and am in the midst of getting my first bridge. The tech who took the x-ray of the area to check the underlying bone exclaimed “oh, you have good bone in your jaw! And that seems to have been my claim to fame over the years from orthopedists when I’ve done something to have to see one. (I used to be very active. Maybe I was too active…my back is going south these days.)

Anyway, admin, if this is not allowed, please remove. The line that determines if you have osteopenia on a Dexa scan was placed arbitrarily way back when because they couldn’t decide when a woman slipped into osteopenia so a doctor said “well, we have to decide on somewhere” and he drew a line. NPR did a good report on how that happened and how the Dexa scan came into being. Because of this and because of the many x-rays I’ve had of my hips/pelvis/knee/ankle, with positive words about my bones from docs, I’m passing on the Dexa scan. I’m intrigued about this REMS test mentioned and will have to research that. On a pelvic scan, a radiologist made a comment on the chart about my “seriously degenerating spine” and that worries me.
https://www.npr.org/2009/12/21/121609815/how-a-bone-disease-grew-to-fit-the-prescription.

Hi all,
I’ve been resisting going on meds the last two years. Doing a lot of homework research on osteoporosis. I see an endocrinologist yearly now. I asked her to order me a REMS scan and she wouldn’t . Hospitals and their imaging centers only take Drs orders.
I found many resources to get a REMs scan even though insurance won’t pay.
I live an hour north of San Francisco. I made an appointment for October 6th with an Osteostrong center in Danville CA. It’s the closest one to me other than San Jose that had appointments available sooner than later.
I just want a clearer picture on my Bone Quality that a Dexa Scan won’t tell me.
REMs scans are new in the US but not in other country’s.
I’m 75 years young, active- daily combining two activities like taking long walks, Pilates, yoga, 50-100 squats daily , eat well, I do drink wine daily which I know doesn’t help. I swim too tho it doesn’t help with bone density.
I’ve read Dr.Lani Simpsons book on Bone Health, I did not buy Dr McCormicks 700 page book which I think is more for professionals in medicine.
I believe if knowing my bone quality is good even tho my bone density isn’t I might be able to avoid taking medications , at least for awhile.
I purchased a vibration plate to see if that helps too. Not sure the difference between the vibration plate and the machine used at Osteostrong centers.
They said the plate doesn’t improve bone density and quality but theirs does .
More research needed. I think of starting AlgaeCal supplements. They won’t accept a REMs scan only a Dexa scan as their money back guarantee so I might wait until my next Dexa before starting the supplements.
That’s all I got for now.

@dorsetgirl65
Hello, I just got a REMS scan at OsteoStrong Happy Valley just outside of Portland. They have a permanent machine and a highly trained technician. They have appts at least two days a week. REMS is highly reliable and the reason endocrinologists know nothing is because they receive no training outside of pill distribution and many choose not to educate themselves further. The DXA scan is highly fallible due primarily to operator and interpretation error - see study published Natl Institute of Health: DXA Errors Are Common and Reduced by Use of a Reporting Template
D Krueger et al. J Clin Densitom. 2019 Jan-Mar. (I’m not allowed to include link)

At 57, I had a diagnosis of severe osteoporosis and no additional testing ordered by the endocrinologist - she wanted me to do 5- yrs of meds right away.
I went away and researched on my own. I went to my GP and asked for a couple blood and urine tests that essentially provide levels of bone sloughing (osteoclast) in my blood to see if they showed similar severe results. All results came back in the normal range, high normal but NORMAL range. I had the results sent to the endo. Endo said your levels are normal, let me know if you want to start medication. What kind of care is that?!
I just got my REMS scan. The technician explained that my L2 and L1 are tucked under (my chiro has said similar in the past) and she had to tilt the wand to get accurate imaging. She said that could be the reason DXA was inaccurate. I also have calcification (CPPD) in my system, which can affect DXA.
My REMS shows osteopenia in spine and femoral neck NOT severe osteoporosis. My fracture risk is in the green - the green is totally healthy!
The endocrinologist was ready to put me on meds that can have serious side effects and make bone more brittle in the long run all based on one DXA and nothing to corroborate. I was also told by her “you cannot reverse osteoporosis” - I don’t believe that when people are improving their bone density all the time with specific weight and impact training, proper nutrition, supplements, and hormone replacement therapy. Check out Osteoporosis Reversal Secrets by Igor Klibanov to start your own research journey.
I would say PLEASE don’t start meds until you know your baselines from multiple angles and try your own interventions. Don’t just trust the meds - our medical system needs to start including training in exercise and nutrition, along with determining the WHY behind a diagnosis. Instead, so many women are diagnosed with a single scan and medicated with dangerous drugs. I’m not alone with my story.

@cfbutler Your REMS is very encouraging and so happy for you. I agree completely about the limitations of DEXA.

However, I am unclear about when you had your last DEXA and its results. Would you be willing to share that info and anything else about what you have been doing that you believe contributed to the great REMS score?

Because insurance will not cover REMS would you also be willing to share the cost you incurred?