DXA vs. REMS Scans

A 75-year-old lady who had been taking strontium citrate (680 mg strontium) for three years, had both a DXA scan and a REMS Echolight scan of her bones. When strontium is incorporated into bone, DXA scan BMD results are falsely elevated because strontium has a higher atomic number than calcium and therefore greater X-ray attenuation. The degree to which the BMD results are falsely elevated depends on the dosage of strontium, the number of years taken, how well the strontium is absorbed and incorporated into bone, the individual bones scanned, and the model of DXA scanner used. REMS is unaffected by strontium in bone. These are her results. You can see that the bone strontium effect varies for each bone scanned. The higher numbers are the DXA scan BMD numbers in g/cm2 and the lower numbers are the REMS scan numbers in g/cm2. The percentages are the difference between DXA numbers and the REMS numbers.

L1-L4   0.775, 0.673, 13.16%

L1   0.698, 0.525, 24.79%

L2   0.763, 0.636, 16.64%

L3  0.805, 0.720, 10.56%

L4. 0.815, 0.773, 5.15% (minimum difference)

Femoral Neck Left  0.772, 0.462, 40.16% (greatest difference)

Hip Total Left  0.750, 0.611, 18.53%

Femoral Neck Right  0.736, 0.467, 36.55%

Hip Total Right. 0.828, 0.617, 25.48%

So, the differences between her DXA and REMS scans varied from a low of 5.15% for L4 to a high of 40.16% for the left femoral neck. 

REMS Scans and Strontium

REMS, which is unaffected by strontium, will show increases in BMD for someone on strontium, but the increases will be real, and, therefore, more modest. I just read a post by a British woman who has been taking strontium citrate (not strontium ranelate, although available in the UK). She has been taking a half dose (340 mg strontium). She just had her third REMS scan, and her spine bone density and fragility scores both improved significantly. Her hip scores stayed the same as those from two years earlier but the hip fragility score was slightly worse. Had she been on the full dose of strontium, her hip scores would most likely have been better. She is a patient of Dr. Nick Birch, the founder of Osteoscan UK, He uses the Echolight REMS system to offer bone health assessments. 

https://healthunlocked.com/bonehealth/posts/149823299/rems-scan-and-strontium-citrate

Credentials of Technologists Performing REMS Echolight Scans

You should always ask about the education and training of the technician performing your REMS Echolight scan. I recently had an online chat with a bot at Precision Bone Imaging, which performs scans at OsteoStrong facilities and other locations in Arizona, California, and Colorado.

I asked: 

What are the credentials of techs performing REMS scans?

The bot answered: 

Our technicians who administer REMS scans at our locations are trained ultrasound technicians. They not only have a background in ultrasound technology but also receive specialized training specific to REMS scanning. This additional training ensures they can perform accurate scans and guide patients smoothly through the process. 

Precision Bone Imaging, 3301 E Indian School Rd, Suite 101, Phoenix, AZ 85018, 

phone (888) 415-7377

https://www.precisionboneimaging.com/

https://app.acuityscheduling.com/schedule.php?owner=32710610

To become an ultrasound technician, you'll need to:

Complete high school

• You'll need a high school diploma or GED to enroll in a college or university program. 

  
  

  Earn an associate's or bachelor's degree
• You can earn an associate's degree in Diagnostic Medical Sonography from an accredited college or university. You can also earn a bachelor's degree in sonography. 

  
  

  Complete a certificate program
• You can complete a one-year certificate program in sonography at a college or hospital. 

  
  

  Complete clinical education
• You'll need to complete clinical education, where you'll apply your formal education in a hands-on setting. 

  
  

  Pass licensing exams
• You'll need to pass the proper licensing exams to become a licensed ultrasound technician.

  
  

  Become certified
• You can become certified through the American Registry for Diagnostic Medical Sonographers (ARDMS) or the American Registry of Radiologic Technologists (ARRT).

  
  

  Some courses you might take in an ultrasound technician program include:

Anatomy and physiology, Medical terminology, Applied sciences, General physics, Pharmacology, and Echocardiography pathology.

Many employers also require candidates to complete basic life support training. 

How to Prepare for an Echolight REMS Scan

1. Wear loose fitting shorts. During cold weather, you can bring shorts with you.

2. Avoid eating a meal or drinking 2-3 hours before your scan.

3. Use the bathroom before the scan. 

Instructions courtesy of Ray Hinish, Pharm.D., Echolight Maryland at OsteoCoach