REMS Bone Health Assessment

01What is REMS?

Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionising ultrasound technology used to assess bone at the lumbar spine and proximal femur.

REMS analyses the raw radiofrequency ultrasound signals acquired during the examination and provides:

• Bone Mineral DensityBMD
• T-score and Z-score
• Lumbar spine and proximal femur assessment
• REMS Fragility ScoreWhere applicable

The Fragility Score is derived from analysis of ultrasound spectral characteristics associated with bone structure and is designed to provide information relating to skeletal fragility in addition to BMD.

REMS is radiation-free and portable, creating opportunities to provide axial bone-health assessment across a range of clinical and community settings.

02The clinical evidence

REMS has a growing peer-reviewed evidence base covering diagnostic performance, comparison with DXA, fracture prediction, precision and repeatability and Fragility Score.

03Current UK position

DXA remains established within current UK osteoporosis assessment pathways.

REMS should not be positioned as a replacement for DXA where DXA, VFA, radiography or other imaging is clinically indicated.

REMS has, however, been considered within NICE’s current osteoporosis guideline update, with its accuracy for predicting fragility fractures specifically identified as a research question.

The developing question is therefore where REMS may add useful information within future and existing bone-health pathways.

04Where could REMS fit?

REMS does not need to occupy the same position within every clinical pathway. Depending on the setting, it could potentially be used:

• As an earlier, accessible bone-health assessment
• Within community or preventative-health pathways
• Where access to conventional densitometry is difficult
• In selected patients where degenerative change may complicate lumbar DXA interpretation
• Alongside or following DXA where additional information relating to skeletal fragility may be useful
• Within appropriate orthopaedic or pre-operative pathways
• For longitudinal assessment where consistent methodology is clinically appropriate

In some settings, REMS may therefore provide an initial bone-health assessment. In others, it may sit later within an established pathway, complementing DXA, other imaging and specialist assessment.

The appropriate role can be agreed with each clinical partner according to its patient population, existing services and clinical pathway.

05The Ravenstone approach

1. 01Measure
2. 02Understand
3. 03Act
4. 04Re-measure

Ravenstone Wellness provides a radiographer-led REMS service in which the assessment is considered within the individual’s wider bone-health picture rather than as an isolated T-score.

Where available, relevant fracture history, risk factors and previous imaging or DXA results can provide additional clinical context.

Where findings indicate osteoporosis, increased fracture risk, unexpected or discordant results, or another clinical concern, the patient is directed to their GP, referring clinician or appropriate specialist for further assessment and management. Where further imaging or investigation is indicated, REMS sits alongside that pathway rather than replacing it.

For clinical partners, reporting, onward referral and communication pathways can be agreed to integrate REMS appropriately within existing services.