Medical professionals have come to realize the importance of monitoring and treating bone health to avoid life-altering fragility fractures. We have to track bone health in the same way we monitor blood pressure and blood sugar to avoid heart disease and diabetes.
Patients are also starting to recognize the need for this kind of screening but are frequently unsure which kind of scan they need and how often it should be done.
In this month’s blog, Dr Bush addresses those two questions.
There are two types of scans currently approved for bone health evaluation and monitoring: DXA and REMS. DXA utilizes ionizing radiation or X-ray while REMS utilizes ultrasound waves. And unlike DXA, REMS scans provide additional information about bone QUALITY. For all these reasons, our providers prefer and use Echolight REMS technology in our Bone Health Program.
The frequency of testing is based on two factors:
-
The condition that's being monitored, and…
-
The ability of the technology to make a meaningful clinical determination (which depends on the Least Significant Change (LSC), or the error rate of the machine) and give you an accurate result.
If you are monitoring a stable bone health condition, testing on a yearly or bi-annual basis may be appropriate. To determine your testing need, we suggest seeking advice from your bone health provider.
However, you should opt for more frequent scanning (possibly every 6 months) if you rely on the test data to make informed medical decisions – such as whether or not to start or continue taking certain medications.
This leads into the second testing frequency factor. REMS has the ability to detect Bone Mineral Density (BMD) changes of less than 1%. Therefore, it may be appropriate to perform more frequent REMS studies if your bone health provider is concerned about active bone loss or wants to monitor the impact of particular medications.
DXA is currently considered the gold standard for BMD monitoring, but unfortunately, it has an LSC (margin of error) of 3% to 5% – which means you would need to show more than 3% to 5% bone loss for the DXA results to be meaningful.
Therefore, it doesn't make sense to do the DXA at frequent intervals. If you’ve experienced a 1% to 2% bone loss within 6 months (a significant loss), a DXA scan would not count the loss as clinically meaningful. There would be no way to tell whether the 1% to 2% loss was accurate or just a fluke due to the machine’s margin of error.
If frequent bone health monitoring is medically necessary, the REMS technology will give you and your bone health provider the high level of accuracy needed for meaningful, frequent testing.
Need bone health evaluation or treatment? Central Carolina Orthopedic Associates would love to partner with you and meet your bone health needs! Schedule your appointment today.