Will the New Ultrasound Device Replace DEXA Bone Density Testing?

Have you ever put your foot in a device that measured bone density in the heel? If so, it was an ultrasound device that tried to detect bone density and bone strength by sending sound waves through the bone. I have been watching the evolution of ultrasound testing for decades and have seen several research articles suggesting that bone ultrasound testing may well uncover strength-determining qualities of bone in addition to bone density.

For example, in 1998, European researchers suggested that quantitative ultrasonography (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 strength. (1)

Today’s New Ultrasound Bone Density Test

Now, two decades later, Italian scientists have developed a modern ultrasound device that is capable of measuring bone in the hip and spine. Extensive tests carried out between 2013 and 2016 suggest that this new Ultrasonic radiofrequency multiple spectrometry (REMS) may be an effective non-radiation way to assess bone density and, even more so, to assess bone strength and fracture risk. The ultrasound device known as the Echolight was recently approved by the FDA and doctors in the US are beginning to test it.

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 she attended an exercise program, and even though she had had her regular DEXA bone density test just 3 days earlier, she accepted the offer. The device is radiation-free and the test is quick and easy, so she was ready to give it a try. However, it turned out that the two bone density measurement devices gave 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 posted articles and talking to people 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 with standard DEXA bone density test machines. For example, the DEXA is operator dependent and placement on the device is an important variable. Entire articles have been written about the common errors that occur with DEXA tests (5). Even more important to me is the fact that the DEXA bone density test does not accurately predict fracture risk, as the vast majority of people who fracture do not have a DEXA “osteoporotic bone density.” (6)

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

My answers to these questions are a work in progress. I reviewed the research and contacted Dr. Kimberly Zambito, an orthopedic surgeon who recently trained in Echolight testing. Having performed more than 25 Echolight REMS scans to date, Dr. Zambito found that new reports of Echolight scanning were 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 get the same results. (7)

While it’s still unclear how this will play 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 of assessing bone density, and perhaps it could 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, give it a try. I would love to see the results. And I’ll follow this research and probably interview some of the key scientists and clinicians who are using this technology.

Stay strong and stay tuned.

References:

1. Prins, SH, et al. 1998. The role of quantitative ultrasonography in the evaluation of bone: a review. Clinical Physiology (Oxford, England) 18(1):3-17.
2. DiPaola, M., et al. 2019. Ultrasound radiofrequency multispectrometry compared with dual X-ray absorptiometry for the diagnosis of osteoporosis in the lumbar spine and femoral neck. Osteoporosis International 30:391-402.
3. Adami, G., et al. 2020. Ultrasound radiofrequency multiple spectrometry for the prediction of incident fragility fractures: a 5-year follow-up study. Bone 134:115297.
4. Cortet, B., et al. 2021. Radiofrequency ultrasound multispectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical setting. Bone 143:115786.
5. Kaleta, M. and S. Wroń 2001. The most common errors in the densitometric diagnosis of osteoporosis. Orthopedics, Traumatology, Rehabilitacja 3(3):338-344.
6. Brown, SE 2015. How can we know 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 Ultrasound Multi-Spectrometry (REMS) Overcome Artifact-Related DXA BMD Limitations? A series of 3 cases. Journal of Ultrasound in Medicine. DOI: 10.1002/jum.15665 published online February 21, 2021.