Osteoporosis is characterised by both low bone mineral density (BMD) and micro-architectural deterioration of bone tissue, leading to decreased bone strength, increased bone fragility and a consequent increase in fracture risk. Fracture is associated with significant morbidity and mortality. Bone mineral density (BMD) can be reliably measured by scanning of the skeleton using dual energy x-ray absorptiometry (DXA) – the current gold standard. However, DXA is associated with ionizing radiation and lack of portability.
Radiofrequency Echographic Multi-Spectrometry (REMS) uses ultrasound to assess bone density at the lumbar spine and hip region, calculating T and Z-scores relative to the National Health and Nutrition Examination Survey (NHANES) reference database. The advantages of REMS are the lack of ionising radiation and portability, raising the possibility of its use as a “point-of-care” tool. Its use has been validated in multi-centre European studies relative to DXA with strong inter-modality correlation in European women with a mean body mass index (BMI) of 24-25 with ability to predict incident fragility fractures. Men have not been included in these larger studies. While osteoporosis is commoner in women, it is also a major issue in men - particularly in those receiving androgen deprivation therapy for prostate cancer. This is not representative of a “real world” Australian population and is particularly important as adipose tissue attenuates sonographic signal, potentially affecting REMS readings at the lumbar spine. There is also no Australian data on the correlation of REMS with DXA readings.
The aim of this pilot validation study is to assess the diagnostic accuracy of REMS compared to gold standard DXA in a Western Sydney population representative of the modern Australian population, and highlight the strengths and weaknesses of using REMS in Australian clinical practice.
(Note: completion of data collection pending)