REMS for the in-vivo assessment of bone strength
An ESCEO expert consensus meeting
Diez-Perez, Brandi, Al-Daghri, Branco, Bruyère, Cavalli, Cooper, Cortet, Dawson-Hughes, Dimai, Gonnelli, Hadji, Halbout, Kaufman, Kurth, Locquet, Maggi, Matijevic, Reginster, Rizzoli & Thierry. Aging Clinical and Experimental Research 31 (2019) 1375–1389. doi.org/10.1007/s40520-019-01294-4
1,900+
Women validated REMS across 7 Italian centres
91.6%
Average sensitivity vs. DXA (spine & femur)
88.5%
Average diagnostic concordance with DXA
FDA 2018
First REMS device cleared for BMD, T-score & Z-score
Why this consensus matters for your bone health
This isn't a single research team reporting its own results. ESCEO — the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases — convened an independent panel of 20 specialists from across Europe and beyond to review every major bone-strength assessment technology available: DXA, quantitative CT, MRI, quantitative ultrasound, microindentation, and REMS.
Their starting point was blunt about the current gold standard: DXA-measured bone density explains only about 50–70% of what actually determines whether a bone breaks. Many fragility fractures happen in patients whose DXA scan looked fine. The panel set out to review what REMS adds where DXA falls short.
Their conclusion, after examining REMS's clinical validation data: it is the first clinically available method for direct, non-ionizing measurement of lumbar and femoral bone density, with diagnostic accuracy that stands up against DXA in a trial of nearly 2,000 women.
What it means in practice: REMS isn't a newer, unproven alternative to established bone density testing — it is a technology that an independent panel of osteoporosis specialists reviewed against the evidence and found to be a validated, radiation-free option.
What the consensus found
Four findings, in plain language.
- 1
REMS matched DXA in a nearly 2,000-patient trial
Across 7 Italian centres, over 1,900 postmenopausal women were scanned with both REMS and DXA. After quality review, 1,195 spinal and 1,373 femoral scans were compared directly — a large enough sample for the panel to draw real conclusions, not a pilot study.
- 2
Sensitivity and specificity both topped 91%
REMS identified osteoporotic patients with 91.7% sensitivity at the spine and 91.5% at the femur, with specificity of 92.0% and 91.8% respectively — meaning it correctly caught patients who had osteoporosis and correctly cleared patients who didn't, at a rate on par with DXA.
- 3
Diagnostic agreement with DXA was strong
Total diagnostic concordance between REMS and DXA — agreement on whether a patient was healthy, osteopenic, or osteoporotic — was 88.8% for lumbar spine and 88.2% for femoral neck, with a Cohen's kappa of 0.82 and 0.79. T-score correlation between the two technologies was r = 0.94 (spine) and r = 0.93 (femur).
- 4
REMS's repeatability beat DXA's own published figures
Both intra-operator and inter-operator precision for REMS were better than the corresponding values typically reported in the literature for DXA itself — meaning REMS gave more consistent, repeatable results between scans and between operators.
Study details
- Full title
- Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength: state of the art—outcomes of an expert consensus meeting organized by ESCEO
- Authors
- Adolfo Diez-Perez, Maria Luisa Brandi, Nasser Al-Daghri, Jaime C. Branco, Olivier Bruyère, Loredana Cavalli, Cyrus Cooper, Bernard Cortet, Bess Dawson-Hughes, Hans Peter Dimai, Stefano Gonnelli, Peyman Hadji, Philippe Halbout, Jean-Marc Kaufman, Andreas Kurth, Medea Locquet, Stefania Maggi, Radmila Matijevic, Jean-Yves Reginster, René Rizzoli, Thomas Thierry
- Journal
- Aging Clinical and Experimental Research, volume 31 (2019), pages 1375–1389
- Published
- 17 August 2019
- DOI
- 10.1007/s40520-019-01294-4
- Population
- Over 1,900 postmenopausal women across 7 Italian centres; 1,195 spinal and 1,373 femoral scans compared after quality review
- Comparison
- REMS diagnostic accuracy versus DXA, the clinical gold standard, for osteoporosis classification
- Key result
- Sensitivity 91.7% (spine) / 91.5% (femur); specificity 92.0% / 91.8%; diagnostic concordance with DXA 88.8% / 88.2%
An expert-validated, radiation-free option
A REMS bone density scan takes about 15 minutes, uses no radiation, and delivers accuracy an independent panel of osteoporosis specialists reviewed against the evidence. Serving patients across New York and New Jersey.
- No radiation at any point during the scan
- FDA-cleared for BMD, T-score, and Z-score measurement
- Safe to repeat for monitoring as often as your physician recommends
More published research on REMS technology is collected on the research library page.