Literature review of Radiofrequency Echographic Multi-Spectrometry (REMS) in the diagnosis of osteoporosis and bone fragility

Background. Osteoporosis is a frequent comorbidity among patients with inflammatory rheumatic diseases, due to the impact of their therapies, the hish systemic inflammation and the large scale use of glucocorticoid treatment. Use of DXA and REMS. Dual X-ray Absorptiometry (DXA) is the “gold standard” for detecting patients with low bone mineral density (BMD), using Z and T scores to define the thresholds for diagnosis of osteopenia and osteoporosis, but this method has proven many disadvantages in time, especially in patients with inflammatory rheumatic diseases, those diagnosed with a disease in the spectrum of spondyloarthritides. Therefore, in the last years, a new method of evaluating bone mineral density (BMD) was developed and benefited from numerous efficiency studies: REMS (Radiofrequency Echographic Multi-Spectrometry). The basis of the method is its ability to identify and analyze native unfiltered ultrasound waves that reflect from the bone surface of the vertebra and femoral neck, the so-called echographic radiofrequency (RF) waves. The analysis of all RF waves spectra allows both a quantitative as well as a qualitative assessment of the bone, thus effectively obtaining estimates of bone resistance and evaluating fracture risk through indirect analysis of bone architecture. Conclusions. The studies concluded that REMS is a method at least as good as DXA in detecting patients with osteoporosis by applying the definitions of the World Health Organization (WHO), and also discovered many advantages of the REMS method, probably the biggest advantages being the ability of this ultrasound method of evaluating bone fragility independent of BMD by introducing the Fragility Score (FS) and the possibility of using the ultrasound method in identifying bone demineralization and fragility in pregnant women. Furthermore, numerous studies begin to recognize the usefulness of REMS in diagnosis and evolution of patients with osteoporosis and inflammatory rheumatic diseases. Discussions. A new concept that should be considered is the fact that REMS could potentially more accurately evaluate BMD and bone fragility through the FS in patients with diseases from the spectrum of spondyloarthritides(especially those with ankylosing spondylitis and psoriatic arthritis).