Could radiofrequency echographic multispectrometry (REMS) overcome the overestimation in BMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine?

Caffarelli, Carla; Pitinca, Maria Dea Tomai; Refaie, Antonella Al; Vita, Michela De; Catapano, Simone; Gonnelli, Stefano

doi:10.1186/s12891-022-05430-6

Cited by 21 publications

(15 citation statements)

References 26 publications

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“…Moreover, these data also reported comparable results between the fracture risk estimates derived by the two technologies. Furthermore, our data supports the robustness of the REMS technique against the influence of AOCs when assessing the lumbar spine BMD, as already suggested in recent case series [19] and in a cross-sectional study [20]. On the contrary, as already shown in previous studies [10,11], AOCs predispose to an artefactual increase in lumbar spine BMD when measured with the commonly adopted anteroposterior approach, with the consequent risk of obtaining a misleading T-score value.…”

Section: Discussionsupporting

confidence: 90%

Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting

et al. 2022

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Background The aim of this real-life cross-sectional explorative study was to compare radiofrequency echographic multi-spectrometry (REMS) with dual-energy X-rays absorptiometry (DXA) in the BMD assessment of patients receiving peritoneal dialysis (PD). Furthermore, we investigated the relationship between lumbar aortic calcifications (AOCs) and the DXA lumbar measurements. Methods Consecutive patients referring to the PD clinic of our hospital were included. Lumbar spine and femur scans were acquired with both techniques (including lumbar laterolateral DXA scans). The risk assessment of two fracture risk algorithms (FRAX® and DeFRA®) were compared. Cohen’s k coefficients were used to assess the inter-technique agreement in the classification of patients as osteoporotic. Lumbar AOCs were estimated semi-quantitatively on laterolateral DXA scans. Results 41 patients were enrolled. No significant differences were documented between the BMD T-scores measured through DXA or REMS at the femur. At the lumbar spine, the DXA anteroposterior mean T-score (− 0.49 ± 1.98) was significantly higher than both the laterolateral DXA (− 1.66 ± 0.99) and the REMS (− 2.00 ± 1.94) measurements (p < 0.01 vs both). No significant differences were found between the DXA and REMS fracture risk estimates with both algorithms. The inter-technique Cohen’s k coefficient (for the worst T-score, any site) was 0.421, p < 0.001. The discrepancy between the DXA laterolateral and anteroposterior lumbar T-score was positively associated with the AOCs extent and severity (r = 0.402, p < 0.01). Conclusions Our data showed a promising agreement, in a real-life PD setting, between DXA and REMS BMD assessment and in the consequent fracture risk estimation and confirm the AOCs interference on the diagnostic accuracy of lumbar DXA.

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Section: Discussionsupporting

confidence: 90%

Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting

et al. 2022

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“…These findings confirm REMS technology’s capability not only to address artifacts related to osteoarthritis but also those associated with spondylitis, vertebral fractures, and vertebroplasty or kyphoplasty operations. This capability enhances the accuracy of osteoporosis diagnosis and, consequently, a better definition of fragility fracture risk [ 21 , 22 ]. However, it’s important to note that the absence of published data on the accuracy of REMS in individuals with a BMI greater than 40 kg/m 2 may represent a limitation in the use of REMS in severely obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a few preliminary reports have documented that REMS technology is able to improve the accuracy of the diagnosis of osteoporosis in cases where lumbar BMD by DXA is impaired by the presence of artifacts from vertebral fractures or osteoarthritis [ 21 , 22 , 23 ]. Therefore, on the basis of these preliminary data, we conducted the DEMETER study.…”

Section: Introductionmentioning

confidence: 99%

The Advantages of Radiofrequency Echographic MultiSpectrometry in the Evaluation of Bone Mineral Density in a Population with Osteoarthritis at the Lumbar Spine

Caffarelli,

Al Refaie,

Mondillo

et al. 2024

Diagnostics

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Background: Osteoarthritis (OA) in the lumbar spine can potentially lead to an overestimation of bone mineral density (BMD), and this can be a challenge in accurately diagnosing conditions like osteoporosis, where precise measurement of BMD is crucial. Radiofrequency Echographic Multi Spectrometry (REMS) is being recognized as an innovative diagnostic tool for assessing bone status. The purpose of this study was to evaluate whether the use of REMS may enhance the identification of osteoporosis in patients with osteoarthritis. Methods: A cohort of 500 patients (mean age: 63.9 ± 11.2 years) diagnosed with osteoarthritis and having a medical prescription for dual-energy X-ray absorptiometry (DXA) were recruited for the study. All patients underwent BMD measurements at lumbar spine and femoral sites by both DXA and REMS techniques. Results: The T-score values for BMD at the lumbar spine (BMD-LS) by DXA were significantly higher with respect to BMD-LS by REMS across all OA severity scores, and the differences were more pronounced in patients with a higher degree of OA severity (p < 0.001). Furthermore, the percentage of subjects classified as “osteoporotic”, on the basis of BMD by REMS was markedly higher than those classified by DXA, both when considering all skeletal sites (39.4% vs. 15.1%, respectively) and the lumbar spine alone (30.5% vs. 6.0%, respectively). A similar pattern was observed when OA patients were grouped according to the Kellgren–Lawrence grading score. Conclusions: The findings from our study indicate that, in a population with varying severity levels of osteoarthritis, REMS demonstrated a higher capability to diagnose osteoporosis compared to DXA, and this could lead to earlier intervention and improved outcomes for patients with bone fragility, reducing the likelihood of fractures and associated complications.

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“…European studies have confirmed the diagnostic precision and reliability of REMS versus DXA [96,97]. An Italian study conducted on a white female population demonstrated that REMS effectively addressed common DXA artifacts, such as OA and vertebral fractures [98]. Ishizu et al found that proximal femur BMD measurements obtained via REMS were significantly lower than those obtained via DXA, while a significant correlation was observed between the HOA Kellgren-Lawrence grade and proximal femoral T-score discrepancies.…”

Section: Diagnosismentioning

confidence: 96%

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

Yokota,

Ishizu,

Miyazaki

et al. 2024

Biomedicines

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The increased incidence of osteoarthritis (OA), particularly knee and hip OA, and osteoporosis (OP), owing to population aging, have escalated the medical expense burden. Osteoarthritis is more prevalent in older women, and the involvement of subchondral bone fragility spotlights its association with OP. Notably, subchondral insufficiency fracture (SIF) may represent a more pronounced condition of OA pathophysiology. This review summarizes the relationship between OA and OP, incorporating recent insights into SIF. Progressive SIF leads to joint collapse and secondary OA and is associated with OP. Furthermore, the thinning and fragility of subchondral bone in early-stage OA suggest that SIF may be a subtype of OA (osteoporosis-related OA, OPOA) characterized by significant subchondral bone damage. The high bone mineral density observed in OA may be overestimated due to osteophytes and sclerosis and can potentially contribute to OPOA. The incidence of OPOA is expected to increase along with population aging. Therefore, prioritizing OP screening, early interventions for patients with early-stage OA, and fracture prevention measures such as rehabilitation, fracture liaison services, nutritional management, and medication guidance are essential.

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Could radiofrequency echographic multispectrometry (REMS) overcome the overestimation in BMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine?

Cited by 21 publications

References 26 publications

Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting

Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting

The Advantages of Radiofrequency Echographic MultiSpectrometry in the Evaluation of Bone Mineral Density in a Population with Osteoarthritis at the Lumbar Spine

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

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