Will the New Ultrasound Device Replace DEXA Bone Density Testing?

Did you ever stick your foot in a device that measured your bone density at the heel? If so, this was an ultrasound device that attempted to detect bone density and bone strength by sending soundwaves through the bone. I have been watching the evolution of ultrasound testing over the decades and have seen several research articles  suggesting that bone ultrasound testing might well be able to uncover the strength-determining qualities of bone in addition to bone density.

For example, in 1998 European researchers suggested that quantitative ultrasound (QUS) represented a promising technique for the diagnosis of osteoporosis and that this radiation-free technology provided information not only on bone density but also on bone quality and bone strength. (1)

The new modern day ultrasound bone density test

Now two decades later Italian scientists have developed a modern ultrasound device that is capable of measuring bone at the hip and the spine. Extensive testing done between 2013 and 2016 suggests that this new Radiofrequency Echographic Multi Spectrometry (REMS) device may be an effective radiation-free way to assess bone density and, even more, to evaluate bone strength and fracture risk. The ultrasound device known as Echolight was recently approved by the FDA and doctors in the US are beginning to give it a try.

A few days ago my client Valerie reported that she was given a free test drive of this new ultrasound device. She was offered a free Echolight test while attending an exercise program, and even though just 3 days before she had had her regular DEXA bone density test, she accepted the offer. The device is radiation-free, and the test is quick and easy, so she was game for a try. As it turned out, however, the two bone density measuring devices delivered quite different results. The new ultrasound device reported substantially lower readings than the DEXA.

This disparity in test results inspired me to dig a little deeper into the Echolight (REMS) research. Looking at their published articles and talking to individuals trained in this new technology confirmed my suspicion that there was a problem here. (2, 3, 4)

We have known for a long time that many errors can occur using the standard DEXA bone density testing machines. For example, the DEXA is operator dependent and placement on the device is an important variable. Whole articles have been written on common errors incurred with DEXA testing (5). Even more important to me is the fact that bone density testing by DEXA does not accurately predict fracture risk, in that the vast majority of people who fracture do not have an “osteoporotic bone density” by DEXA. (6)

So which bone density test was more accurate in Valerie’s case? And will REMS replace DEXA?

My answers to these questions are a work in progress. I looked at the research and contacted Dr. Kimberly Zambito, an orthopedic surgeon who was recently trained in Echolight testing. Having done 25+ Echolight REMS scans so far, Dr. Zambito found the new Echolight scan reports to be consistent with DEXA in terms of bone mineral density, except for those patients who had poor quality DEXA scans. I guess time will tell if careful researchers will come up with the same results. (7)

While it is still not clear how this will turn out in Valerie’s case, or if the new ultrasound will replace DEXA, I wanted to share this new technology with you. I have an intuitive feeling that ultrasound has the potential to provide a safer and even more accurate way to assess bone density, and perhaps it might even tell us a bit more about bone strength and fracture risk.

If you are offered an Echolight test, and it happens to be around the same time as your DEXA bone density test, try it out. I would love to see the results. And I will be following this research and may likely interview a few of the key scientists and physicians using this technology.

Stay strong, and stay tuned in.

References:

1. Prins, S. H., et al. 1998. The role of quantitative ultrasound in the assessment of bone: A review. Clinical Physiology (Oxford, England) 18(1):3-17.
2. Di Paola, M., et al. 2019. Radiofrequency echographic multispectrometry compared with dual X-ray absorptiometry for osteoporosis diagnosis on lumbar spine and femoral neck. Osteoporosis International 30:391-402.
3. Adami, G., et al. 2020. Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures: A 5-year follow-up study. Bone 134:115297.
4. Cortet, B., et al. 2021. Radiofrequency echographic multi spectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical context. Bone 143:115786.
5. Kaleta, M., and S. Wroń 2001. The most common errors in the densitometric diagnosis of osteoporosis. Ortopedia, Traumatologia, Rehabilitacja 3(3):338-344.
6. Brown, S. E. 2015. How can we tell who will fracture? Beyond bone mineral density to the new world of fracture risk assessment. Better Bones website, accessed April 21, 2021.
7. Dea Tomai Pitinca, M., et al. 2021. Could radiofrequency echographic multi-spectrometry (REMS) overcome the limitations of BMD by DXA related to artifacts? A series of 3 cases. Journal of Ultrasound in Medicine. DOI: 10.1002/jum.15665 published online 21 February 2021.