REMS confusion

Posted by glojo @glojo, Feb 21 9:02am

I had the opportunity to receive a REMS while visiting family in Dallas, and I find the results puzzling. My most recent DEXA is from two years ago, and I’m scheduled for an update in a few weeks, but I am hoping to have at least slowed the rate of decrease with two years of added supplementation and intense exercise. I have never fractured. I did expect the REMS to be in the ballpark of the DEXA, but that did not happen.

From DEXA 2022:

Lumbar T-score -3.2; Femoral necks -1.4 and -1.9; TBS -2.0; FRAX 10% major and 1.6% hip; Vertebral Fracture Analysis normal

From REMS : Lumbar T-score -1.8; Femoral necks -2.2 and -2.3; Fragility score for spine 31.9; Fragility score for hips 41.9

I understand the different technologies involved in how these machines measure density; however, with such striking contrasts, it’s hard to know which to believe. Seems illogical to accept REMS lumbar score and the DEXA femur score, while ignoring the REMS femur score and the DEXA lumbar score. Looking for others who have had the opportunity to do REMS and end up more confused than before. I am looking for as much information as possible to either push me to start Tymlos or justify my continued refusal of medications. Thoughts?

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The two sets of results are quite different, but as your DEXA is from two years ago, I would think you should wait to compare once you have the next DEXA. I have read the DEXA results can be quite different as well from one machine to another, and one operator to another. Are you having the next DEXA at the same place? REMS is supposed to be more reliable from that perspective. I had a DEXA in November, and I've just had a REMS a couple of weeks ago. The two are not that different, but better results with REMS, and a more positive fracture score. Overall, not huge differences, but I am somewhat relieved that my fracture risk is lower, due to bone strength, not just a measurement of the actual density.

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@ajpost

The two sets of results are quite different, but as your DEXA is from two years ago, I would think you should wait to compare once you have the next DEXA. I have read the DEXA results can be quite different as well from one machine to another, and one operator to another. Are you having the next DEXA at the same place? REMS is supposed to be more reliable from that perspective. I had a DEXA in November, and I've just had a REMS a couple of weeks ago. The two are not that different, but better results with REMS, and a more positive fracture score. Overall, not huge differences, but I am somewhat relieved that my fracture risk is lower, due to bone strength, not just a measurement of the actual density.

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I had an updated DEXA this week, and it shows consistent decline in the lumbar, with stable results in femur. Went from -3.2 to -3.7 lumbar, but -1.6 femur. Same machine as 2022, although different tech who seemed more interested in idle chitchat. So I don’t know what to think.

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Let’s keep this discussion going. And wondering if anyone has had both the DEXA with TBS and a REMS - to see how they compare????

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@glojo

I had an updated DEXA this week, and it shows consistent decline in the lumbar, with stable results in femur. Went from -3.2 to -3.7 lumbar, but -1.6 femur. Same machine as 2022, although different tech who seemed more interested in idle chitchat. So I don’t know what to think.

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I don't know what to think either. My best guess is that one or more of these readings is off.
The DXA and the REMS should not be so far apart on the spine or the hips.
The two DXA scans are close enough to each other to be reasonable. Some loss in spine but the same in the hip. That would not be uncommon.

Hopefully we'll get enough people doing both types of scans to begin to see a pattern and find out if the REMS test is worthwhile or maybe even a significant improvement. It's certainly a nice idea but we've got to know if it really works.

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@glojo OsteoBoston posted a presentation last week by Dr. Kim Zambito on REMS Echolight Technologies, available at https://www.youtube.com/watch?v=r7vViRvAizA. I don't know if it helps with your question but she gives a very good overview of various bone scan technologies and briefly discusses the REMS report, REMS fragility score, etc. Around minute 26, one of Dr. Zambito's take home messages is that one needs to compare DXA to DXA and REMS to REMS over time, that one should not mix and match.

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