Difference in scores between DEXA and REMS

@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?

I just got a REMS scan and I am devastated by the results. According to the report, the BMD of my right femur decreased by over 40% in the less than 2 years since my last DEXA. This seems impossible. I get enough calcium from diet and take vitamin D and K2 supplements. I have lots of energy and don't have any pain. I walk several miles most days, eat healthily, take Estradial, do light weight lifting 5 days a week and dead-lifting two days week.

I have DEXA data going back 24 years. In all that time I have never had a femur T-score below -1.5. This test showed -3.1. I've schedule a DEXA and am hoping that the REMS data is an error. The REMS showed that the BMD of my spine decreased slightly. That's not shocking. (I'm 68 years old. ) The bone quality scores weren't bad. About 35 for the femur and 32 for the spine.

Ever since I've started getting bone scans, the BMD of my hip has always been much better than for my spine. This is a shocking reversal.

@rjd
My DXA was in late October and my T-scores were as follows:
Spine -2.9 (REMS -1.7, fragility score 27.7/100 which is green/good)
Femoral neck -2.4 (REMs -1.6, fragility score 21.6/100)
Hip -1.6 (no REMS) - lengthy and more expensive

Fragility score is ability to absorb force and is not measured by DXA or related to T-score. You only get this with examination of the trabecular layer with REMS.

Cost of REMS was $275.

I insisted on a CTX and P1NP tests from my GP for bone mineral in blood and urine to corroborate the DXA and they did not return results aligned to severe osteoporosis which furthered my decision to do REMS.

I started doing research about reversing osteoporosis and read Igor Klibanov’s book - a great starter, found Dr. Doug on YouTube and appreciate the free version of OsteoCollective, and found Dr. Nick Birch on YouTube- I can’t give link - look up “Understanding bone health a deep dive with dr nick birch” for a good intro. I do use medical journals and sports medicine journals only for research backed decision making, not any articles I find online.

I have been supplementing with collagen, k2, boron, magnesium, manganese, calcium, d3, vit C, and soy isoflavens prior to going on HRT. My GP finally agreed to HRT with the osteoporosis diagnosis but women shouldn’t have to wait for that. I also increased my protein intake to at least 100 grams a day (I know that’s a lot but protein is the building block of bones).

Being completely dismissed by the endocrinologist when I brought up exercise and diet, I chose to find a naturopath MD. He ran multiple mineral blood tests and Celiac’s disease (apparently symptoms aren’t always obvious and Celiac’s can deter the absorption of critical bone minerals leading to osteoporosis). I am waiting for my next appt and expect to add testosterone to my HRT regime.

I also made the decision to work with a personal trainer for a few months to make sure the weight and impact training I do is safe. Two things about that. One, I am fortunate to be able to push aside some things to make financial room for personal training for a few months - it is expensive. Along those lines, I took some time at 3 gyms to ask trainers what they understood about osteoporosis before making my decision on who to work with - it is expensive and I want it to make an impact. My focus is on building up to heavy weights and proper form. If you don’t feel comfortable talking to the trainer or you feel they are unprepared for the meeting, I’d say run the other way.

I currently do weight training 3x/week and do heel drops (still with shoes on), step off stair, and hip bumps for impact training 2x/ wk - biggest bone builders but must be done with caution as they can cause stress fractures.

Good luck in your journey and don’t let the docs get off with their checklist approach.

@rjd
My DXA was in late October and my T-scores were as follows:
Spine -2.9 (REMS -1.7, fragility score 27.7/100 which is green/good)
Femoral neck -2.4 (REMs -1.6, fragility score 21.6/100)
Hip -1.6 (no REMS) - lengthy and more expensive

Fragility score is ability to absorb force and is not measured by DXA or related to T-score. You only get this with examination of the trabecular layer with REMS.

Cost of REMS was $275.

I insisted on a CTX and P1NP tests from my GP for bone mineral in blood and urine to corroborate the DXA and they did not return results aligned to severe osteoporosis which furthered my decision to do REMS.

I started doing research about reversing osteoporosis and read Igor Klibanov’s book - a great starter, found Dr. Doug on YouTube and appreciate the free version of OsteoCollective, and found Dr. Nick Birch on YouTube- I can’t give link - look up “Understanding bone health a deep dive with dr nick birch” for a good intro. I do use medical journals and sports medicine journals only for research backed decision making, not any articles I find online.

I have been supplementing with collagen, k2, boron, magnesium, manganese, calcium, d3, vit C, and soy isoflavens prior to going on HRT. My GP finally agreed to HRT with the osteoporosis diagnosis but women shouldn’t have to wait for that. I also increased my protein intake to at least 100 grams a day (I know that’s a lot but protein is the building block of bones).

Being completely dismissed by the endocrinologist when I brought up exercise and diet, I chose to find a naturopath MD. He ran multiple mineral blood tests and Celiac’s disease (apparently symptoms aren’t always obvious and Celiac’s can deter the absorption of critical bone minerals leading to osteoporosis). I am waiting for my next appt and expect to add testosterone to my HRT regime.

I also made the decision to work with a personal trainer for a few months to make sure the weight and impact training I do is safe. Two things about that. One, I am fortunate to be able to push aside some things to make financial room for personal training for a few months - it is expensive. Along those lines, I took some time at 3 gyms to ask trainers what they understood about osteoporosis before making my decision on who to work with - it is expensive and I want it to make an impact. My focus is on building up to heavy weights and proper form. If you don’t feel comfortable talking to the trainer or you feel they are unprepared for the meeting, I’d say run the other way.

I currently do weight training 3x/week and do heel drops (still with shoes on), step off stair, and hip bumps for impact training 2x/ wk - biggest bone builders but must be done with caution as they can cause stress fractures.

Good luck in your journey and don’t let the docs get off with their checklist approach.

I just got a REMS scan and I am devastated by the results. According to the report, the BMD of my right femur decreased by over 40% in the less than 2 years since my last DEXA. This seems impossible. I get enough calcium from diet and take vitamin D and K2 supplements. I have lots of energy and don't have any pain. I walk several miles most days, eat healthily, take Estradial, do light weight lifting 5 days a week and dead-lifting two days week.

I have DEXA data going back 24 years. In all that time I have never had a femur T-score below -1.5. This test showed -3.1. I've schedule a DEXA and am hoping that the REMS data is an error. The REMS showed that the BMD of my spine decreased slightly. That's not shocking. (I'm 68 years old. ) The bone quality scores weren't bad. About 35 for the femur and 32 for the spine.

Ever since I've started getting bone scans, the BMD of my hip has always been much better than for my spine. This is a shocking reversal.

@cfbutler What are "hip bumps"?