Understanding the Echolight REMS Fragility Score: A Simple Guide

So, you’ve heard about Echolight REMS and you’ve probably come across groups or blogs where the REMS is touted as superior to DEXA.

…and it is, but why?

Traditionally, doctors have used methods like DXA (Dual-energy X-ray Absorptiometry) to measure bone density, and it is considered the gold standard mostly because it was first on the scene. The problem is, this methods don’t always tell the whole story about bone health, in fact, it almost NEVER tells the whole story as indicated by the fact that most fractures occur in people who are not considered osteoporotic by DEXA.

One of the big benefits of the Echolight over the DEXA, and arguably the biggest reason why Echolight will one day win the title as the gold standard, is the propietary “Fragility score” delivered by the Echolight REMS. 

First let’s talk about what Echolight is and how it works…

Echolight REMS is a newer technology (been on the market for a little over 10 years) that helps doctors understand bone health better than DEXA. REMS stands for Radiofrequency Echographic Multi-Spectrometry. This method is different because it doesn’t use radiation and is non-invasive, meaning it doesn’t need to go inside the body.

How Does Echolight REMS Work?

Here’s a simple breakdown of how it works:

1. Sending Signals**: The device sends out sound waves into the bone.
2. Catching Echoes**: These waves bounce back to the device after hitting the bone.
3. Smart Analysis**: The device analyzes these returned signals using advanced technology.
4. Creating the Fragility Score**: This analysis is then used to create a Fragility Score, which tells us how strong or weak the bone is.

Understanding the Fragility Score

The Fragility Score is a number that ranges from 0 to 100. Unlike some scores where higher is better, with the Fragility Score, a lower number means stronger, healthier bones.

What Do the Scores Mean?

• 0-20: Low Fragility – Bones are strong and healthy and are at low risk of fracture.
• 21-40: Moderate Fragility – Bones are fairly strong but might show some early signs of weakness. Moderate risk of fractures. It’s a good idea to start preventive measures like diet changes and exercise.
• 41-60: High Fragility – Bones are weaker, with noticeable signs of reduced strength. High risk of fractures. Medical treatment may be needed.
• 61-100: Very High Fragility – Bones are very weak and fragile. Very high risk of fractures. Immediate medical attention is necessary.

Why Echolight REMS is Better Than DXA

One of the biggest advantages of Echolight REMS is that it doesn’t use radiation. DXA, on the other hand, uses X-rays, which means every test exposures you to a little radiation. This makes REMS a safer choice, especially for children, pregnant women, and those needing frequent testing.

DXA mainly measures bone mineral density (BMD). While this is important, it doesn’t give a full picture of bone health. Echolight REMS goes further by also looking at bone quality and structure, giving a more complete understanding of bone strength.

Echolight REMS tests are quick and can be done in a few minutes. This makes the process more comfortable and convenient compared to DXA, which can take longer and might need special facilities.

REMS technology can analyze both trabecular (spongy) and cortical (hard) bone. This helps in understanding different parts of the bone structure, something DXA doesn’t do as thoroughly.

DXA requires a highly trained and experienced technician to position the body properly. If the technician is not well trained or is rushed, as many DXA technicians are, then it can cause the results to be unacceptably inaccurate. REMS is much more forgiving and utilizes advanced technology to toss out inaccurate results and unwanted anomalies. 

One of the standout benefits of Echolight REMS is its ability to detect smaller changes in bone health. Because REMS technology provides a more detailed and sensitive analysis, it can pick up on minor variations in bone quality and density that DXA might miss. This is crucial for early detection of bone issues and for monitoring the effectiveness of treatments more closely. 

REMS Allows You To See Changes Sooner

For people already receiving treatment for bone issues, regular monitoring is crucial. Echolight REMS allows for more frequent testing because it doesn’t use radiation. You can retest as often as needed, even every few months, to see how well the treatment is working. 

With DXA, because of the radiation exposure, tests are usually done once every two years. The ability to see smaller changes with REMS means doctors can make quicker and more accurate adjustments to treatment plans.

Echolight REMS Works Better For Many Groups of People

Certain groups, like older adults and postmenopausal women, are more likely to have bone problems. Regular checks with Echolight REMS can help these people take action before serious problems arise, such as fractures.

Echolight REMS offers advantages for various populations where DXA might not be the best fit:

• Thin Women: DXA can sometimes give inaccurate readings for very thin women. REMS provides more reliable results by looking at both bone quality and density.
• Diabetics: Diabetes can affect bone health in complex ways. REMS helps in understanding these effects better by providing a detailed analysis of bone structure.
• People with Arthritis: Arthritis can cause changes in bone that can make the bones look more dense than they are in actuality. REMS technology can detect these changes more accurately and remove anomalies, helping to diagnose and manage the condition better.
• Obese People: Excess body fat can interfere with DXA readings. REMS can offer a clearer picture by focusing on the bone itself rather than being affected by surrounding tissues.

Echolight REMS is Better at Fracture Risk Detection

Imagine we put cars in a race and we were studying how likely a car would be to finish the race without crashing. 

The car race represents the challenge of predicting fractures. The Area Under the Curve (AUC) is like measuring how likely a car is to make it through the race without crashing (fracturing). 

If a car has an AUC of 1, it means the car will make it through the race every time without crashing. 

If a car has an AUC of 0.5, it means the car is not very reliable and it has a 50/50 chance of getting to the finish line in one piece…in other words, if you drive that car, you’re simply flipping a coin. It’s a game of chance. 

In the study published in “Aging Clinical and Experimental Research,” REMS was like a race car with an AUC of 0.811 for women and 0.835 for men. This means REMS was very good at predicting which people would have fractures. 

On the other hand, DXA, with lower AUC values, was more like a car that struggled on the track and crashed more often, making more mistakes and being less reliable in predicting fractures.

The study showed that REMS is significantly better at predicting fracture risk compared to DXA… 

REMS provided an AUC of 0.811 for women and 0.835 for men, indicating high accuracy in distinguishing between those who would and would not experience fractures. In contrast, DXA had lower AUC values, making it less effective in predicting fractures. This higher accuracy of REMS means doctors can trust it more to identify patients at risk and take preventive actions sooner.

Conclusion: A Better Way to Understand Bone Health

Echolight REMS and its Fragility Score offer a better way to understand and manage bone health. This technology is safe, accurate, and gives a complete picture of how strong our bones are. By using this tool, doctors can make better decisions to help keep our bones healthy and strong.

References

1. [Echolight Medical](https://www.echolightmedical.com/technology)
2. Pisani, P., et al. “Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques.” World Journal of Radiology, 2019.
3. Di Paola, M., et al. “Radiofrequency echographic multi-spectrometry compared with dual-energy X-ray absorptiometry for osteoporosis diagnosis on lumbar spine and femoral neck.” Osteoporosis International, 2018.
4. Nuti, R., et al. “New perspectives on the definition and criteria of osteoporosis.” Clinical Cases in Mineral and Bone Metabolism, 2019.
5. Pisani, P., Conversano, F., Muratore, M., et al. “Fragility Score: a REMS-based indicator for the prediction of incident fragility fractures at 5 years.” Aging Clinical and Experimental Research, 2023.