Difference in scores between DEXA and REMS

@cfbutler This is really encouraging and why I want to get a REMS too, basically a 2nd opinion. When I've had a recommendation from a car repair place to do something that is expensive and questionable if really the issue or true, I have gotten a 2nd opinion and in most cases, have gotten a different answer about what is really necessary/needed and it has always been that something is not needed etc. I'm taking the same approach for my osteoporosis. This post confirms that, thank you for sharing!

@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 I agree with you.

I had my first DEXA scan in July 2024, and I was told I have severe osteoporosis in my lumbar spine. Going forward, I had breast cancer in July 2025, and I was put on hormone blocker medication, which will damage the bones due to a lack of estrogen. In November, I had a REMS scan and showed osteopnea. They want me to start bone medication called Zometa, which I've been refusing. Had another DEXA done a few days ago, and it has gotten worse. Scheduled for REMS scan at the end of this month to compare the results again.
Doctors' focus is to give you medication, the only solution they have, which is so frustrating. They don't understand how difficult it is to be in a physical and emotional stage.

@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
I would so appreciate it if you would consider posting this on the Inspire osteoporosis site. Mayo is so lucky to have you, and I would love for Inspire posters to benefit from your insights.

@kathleen1314
Thank you for your kind words. I work a look into Inspire and was sad to see one person being pressed by doc to go on Evenity for wrist -2.9 while spine and hip are osteopenia. That’s a huge difference and does the person know why?! I will join just to ask the questions. It may be good advice but I hope the person asks a bunch of questions first.

Thank you for the information given. I appreciate that Dr. Bushes website. I wish I had this resource in my area. I learned about the REMS thru this osteoporosis support group. I live on the west coast so am having to travel to Canada to get a REMS. Will have to try and interpret the results myself since no one in my state gives or knows how to read this test. But I do like the fact that I can get one of these REMS in Canada and monitor my osteoporosis without having to wait 2 years to get an updated DEXA scan. Currently waiting to get an appointment with an endocrinologist. Wait times in Oregon can be 3-6 month. I appreciate your commitment to advocating for your health. It’s what I have learned over time. Keep asking questions, keep seeking that Dr. who will work with you. I want information and 1 year to figure out whether to take the Fosomax I was automatically prescribed by my PCP or if I can make positive changes in spine scores through vitamins, impact training and diet.