REMS and DXA in a peritoneal dialysis setting
A real-life comparison study
Fassio, Andreola, Gatti, Bianco, Gatti, Gambaro, Rossini, Viapiana, Negrelli & Adami. Aging Clinical and Experimental Research 35 (2023) 185–192. doi.org/10.1007/s40520-022-02286-7
41
Patients receiving peritoneal dialysis studied
k = 0.78
Substantial DXA/REMS agreement at the total hip
No sig. diff.
Fracture risk estimates matched between technologies
Artifact-resistant
REMS unaffected by aortic calcification errors
Why this study matters for your bone health
Chronic kidney disease brings its own bone problem: patients on dialysis face a sharply increased risk of fragility fractures, and DXA — the technology used to screen for that risk — has a specific blind spot in this population. Calcified deposits in the wall of the aorta, common in dialysis patients, sit right behind the lumbar spine and can make a standard DXA scan overestimate bone density, masking exactly the risk it's meant to catch.
Researchers at the University of Verona set out to test whether REMS could serve dialysis patients better. They studied 41 patients receiving peritoneal dialysis, scanning each one with both REMS and DXA at the spine and hip, and comparing the two technologies' agreement on osteoporosis diagnosis and fracture risk.
Their finding: REMS and DXA showed promising agreement overall, and REMS proved resistant to the exact artifact that distorts standard DXA readings in this population.
What it means in practice: for patients managing chronic kidney disease or dialysis, a testing method that isn't thrown off by arterial calcification means a more trustworthy bone density reading — and a screening option that doesn't compound existing health complexity with radiation exposure.
This is an exploratory study — the authors are careful to note its small sample size and the absence of a control group as limitations. But it's the first study of its kind in a real-life dialysis setting, and its authors call for longitudinal research to confirm the pattern over time.
What the study found
Four findings, in plain language.
- 1
REMS and DXA agreed closely at the hip
At the femoral neck and total hip, there was no statistically significant difference between REMS and DXA T-scores. Agreement at the total hip was rated "substantial" (Cohen's kappa 0.784) — a strong level of diagnostic consistency between the two technologies.
- 2
Fracture risk estimates matched between technologies
Two established fracture risk calculators (FRAX and DeFRA) produced comparable results whether fed REMS data or DXA data, with no statistically significant differences — meaning either technology reached the same clinical risk conclusion for these patients.
- 3
REMS resisted an artifact that distorts standard DXA readings
Aortic calcifications — common in dialysis patients — significantly inflated the standard (anteroposterior) DXA reading at the lumbar spine, but had far less effect on REMS. This matters because that DXA artifact can mask real bone loss in exactly the patients most at risk.
- 4
Bone density correlated with calcification severity, as expected
Both REMS and DXA showed lower bone density scores associated with more severe aortic calcification at nearly every site measured — confirming REMS tracks the same underlying skeletal decline that DXA has long been used to detect.
Study details
- Full title
- Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting
- Authors
- Angelo Fassio, Stefano Andreola, Davide Gatti, Beatrice Bianco, Matteo Gatti, Giovanni Gambaro, Maurizio Rossini, Ombretta Viapiana, Riccardo Negrelli, Giovanni Adami
- Journal
- Aging Clinical and Experimental Research, volume 35 (2023), pages 185–192
- Published
- 3 November 2022
- DOI
- 10.1007/s40520-022-02286-7
- Population
- 41 patients receiving peritoneal dialysis at a single hospital's nephrology clinic
- Comparison
- REMS vs. DXA bone density, osteoporosis classification, and fracture risk, including the impact of aortic calcification on accuracy
- Key result
- No significant DXA/REMS difference at the femur; substantial agreement at the hip (κ = 0.784); REMS resisted the artifact that inflates standard DXA lumbar readings
A bone density reading you can trust
A REMS bone density scan takes about 15 minutes, uses no radiation, and resists the artifacts that can distort readings for patients managing complex health conditions. Serving patients across New York and New Jersey.
- No radiation at any point during the scan
- Resistant to calcification artifacts that can distort other bone scans
- Safe to repeat for monitoring as often as your physician recommends
More published research on REMS technology is collected on the research library page.