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.