Ability of radiofrequency echographic multispectrometry to identify osteoporosis status in elderly women with type 2 diabetes

Abstract

Background Patients with type 2 diabetes (T2DM) have an increased or normal BMD; however fragility fractures represent one of the most important complications of T2DM. Aims This study aimed to evaluate whether the use of the Radiofrequency Echographic multi spectrometry (REMS) technique may improve the identification of osteoporosis in T2DM patients. Methods In a cohort of 90 consecutive postmenopausal elderly (70.5 ± 7.6 years) women with T2DM and in 90 healthy controls we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and total hip (TH-BMD) using a dual-energy X-ray absorptiometry device; moreover, REMS scans were also carried out at the same axial sites. Results DXA measurements were all higher in T2DM than in non-T2DM women; instead, all REMS measurements were lower in T2DM than in non T2DM women. Moreover, the percentage of T2DM women classified as “osteoporotic”, on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (47.0% vs 28.0%, respectively). On the contrary, the percentage of T2DM women classified as osteopenic or normal by DXA was higher with respect to that by REMS (48.8% and 23.2% vs 38.6% and 14.5%, respectively). T2DM women with fragility fractures presented lower values of both BMD-LS by DXA and BMD-LS by REMS with respect to those without fractures; however, the difference was significant only for BMD-LS by REMS (p < 0.05). Conclusions Our data suggest that REMS technology may represent a useful approach to enhance the diagnosis of osteoporosis in patients with T2DM.

Could radiofrequency echographic multispectrometry (REMS) overcome the overestimation in BMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine?

“…REMS technology by the analysis of natural raw unfiltered ultrasound signals appears to be able to recognize and automatically remove the raw signal of osteophytes, calcifications and other possible causes of artifacts, thus permitting a correct definition of osteoporosis and consequently a better assessment of fragility fracture risk [ 16 , 17 , 24 ]. However, the lack of published data on the accuracy of REMS in subjects with BMI > 40 kg /m2 may represent a limit to the use of REMS in very severely obese patients.…”

“…The technical characteristics of the REMS device and the methods of carrying out the measurements have been described in detail in previous papers from our and other groups [ 9 , 10 , 12 , 16 , 17 ]. Briefly, the analysis of backscattered row signals allows us to obtain a spectral model for each subject that undergoes an advanced comparison with reference spectral models resulting in a BMD estimation and in the consequent diagnostic classification as normal, osteopenic or osteoporotic [ 10 , 12 , 16 ].…”

Radiofrequency Echographic Multispectrometry (Rems): An Innovative Technique For The Assessment Of Bone Status In Young Women With Anorexia Nervosa

“…In addition to the reduction of BMD, bone involvement in patients with AN is characterized by several structural defects (such as reduced cortical thickness at the radius and femur, increased bone marrow fat, alterations of the microarchitecture) which lead to worsening of bone strength and increased risk of fragility fractures [2,8]. One of the most interesting points of the REMS approach is represented by the fact that this technique seems to have the potential to identify parameters other than BMD linked to qualitative and structural characteristics of bone [19,27]. Although currently there are no data available to hypothesize that REMS can provide information on bone quality alterations in AN, the fact that in this study only BMD-TH by REMS was signi cantly lower in women with AN and previous vertebral fracture with respect to those without fracture may be interesting and represents a stimulus for future research in this eld.…”

“…In Figure 1 showed a schematic representation of the REMS acquisition on femoral neck. Data processing methodologies implemented in the REMS approach were detailed in previous papers [16,18,19].…”

“…Some papers have reported that REMS technique present a good precision and a diagnostic accuracy similar to DXA [16,17]. In addition, recent studies have demonstrated the ability of the REMS technique to diagnose osteoporosis and to predict the risk of fragility fracture in female population [16,18,19].…”