Bone densitometry by REMS: a clinical review
The first Polish-authored review of REMS densitometry
Iwaszkiewicz & Leszczyński. Forum Reumatologiczne 5(2) (2019) 81–88. doi.org/10.5603/FR.2019.0011
91.5–91.7%
REMS sensitivity vs. DXA, hip and spine
FDA 2018
REMS densitometer cleared under 510(k)
1,914 women
Largest cited multicenter validation study
First of its kind
First Polish-language paper on REMS densitometry
Why this review matters for your bone health
This paper isn't a single clinical trial — it's a comprehensive review written by two rheumatologists at Poznan University of Medical Sciences to summarize everything known about REMS at the time, for other physicians deciding whether to trust it. It's a useful document for a patient too, because it plainly lays out what REMS is, how it compares to DXA, and where its limitations are — without an agenda to promote the technology.
The authors start from a candid assessment of DXA, the current gold standard: it carries a high risk of false negative results, requires highly trained staff, isn't very portable, costs more, requires a specific patient position, and comes with the regulatory and legal weight of ionizing radiation. REMS, they explain, was developed specifically as a response to those limitations — not a replacement attempt, but a genuine alternative designed around DXA's weak points.
Importantly, the review distinguishes REMS from older ultrasound-based screening tools (QUS), which the authors note cannot assess bone at the hip or spine and are not equivalent to true densitometry. REMS, by contrast, measures BMD in the same units and at the same central sites as DXA — which is why the authors describe it as comparable to DXA, not merely an ultrasound proxy for it.
What it means in practice: REMS's built-in quality control automatically rejects a scan if the signal isn't good enough for a reliable reading — rather than relying entirely on an operator's judgment, as DXA does. That's a meaningful safeguard against a false result.
What the review found
Four findings, in plain language.
- 1
The largest validation study showed strong accuracy
The review cites a 2018 multicenter study of 1,914 postmenopausal women, which found REMS sensitivity of 91.5% (femoral neck) and 91.7% (lumbar spine), specificity of 91.8% and 92.0%, and diagnostic concordance with DXA of 88.2% and 88.8% — high marks across every accuracy measure that matters clinically.
- 2
REMS was more repeatable than DXA's own published figures
In that same study, REMS's intra-operator repeatability (RMS-CV) was 0.32% at the femoral neck and 0.38% at the lumbar spine, compared to figures of 1.47% and 1.07-1.34% reported in the literature for DXA — suggesting REMS produces more consistent results between repeated scans.
- 3
REMS received FDA clearance in October 2018
The U.S. Food and Drug Administration cleared the REMS densitometer (EchoS, by Echolight S.p.A.) under the 510(k) pathway, confirming the existence of reliable data comparing REMS and DXA and validating its diagnostic parameters: BMD, T-score, Z-score, and integrated FRAX fracture risk assessment.
- 4
The authors are candid about REMS's own limitations
This isn't a one-sided endorsement. The authors note real limitations: reduced accuracy in obese patients (diagnostic accuracy dropped to 69.6% in overweight/obese women aged 66-80 in one cited study), potential difficulty imaging the spine shortly after a meal, and the fact that no prospective study has yet directly linked REMS results to actual fracture risk over time.
Study details
- Full title
- Bone densitometry by radiofrequency echographic multi-spectrometry (REMS) in the diagnosis of osteoporosis
- Authors
- Cezary Iwaszkiewicz, Piotr Leszczyński
- Affiliation
- Department of Rheumatology and Osteoporosis, Jozef Strus Hospital, Poznan; Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences
- Journal
- Forum Reumatologiczne, volume 5, issue 2 (2019), pages 81–88
- DOI
- 10.5603/FR.2019.0011
- Type
- Clinical review — the first Polish-language paper on REMS densitometry, per the authors
- Key data cited
- 1,914-patient multicenter validation study: sensitivity 91.5-91.7%, specificity 91.8-92.0%, diagnostic concordance 88.2-88.8% vs. DXA
- Regulatory milestone
- REMS densitometer (EchoS, Echolight S.p.A.) received FDA 510(k) clearance in October 2018
An FDA-cleared, radiation-free option
A REMS bone density scan takes about 15 minutes, uses no radiation, and is built on an automated algorithm that flags its own unreliable scans rather than leaving accuracy to chance. Serving patients across New York and New Jersey.
- No radiation at any point during the scan
- FDA-cleared and validated against DXA in large clinical studies
- Safe to repeat for monitoring as often as your physician recommends
More published research on REMS technology is collected on the research library page.