Abstract
Introduction Fragility bone fractures impact patient’s quality of life and worldwide healthcare systems: accurate technologies and device are required in order to early diagnose and monitor the effect of osteoporosis on a mass-population basis. Several studied have analysed the pros and cons of the numerous technologies available nowadays for the diagnosis and monitoring of bone health, highlighting the need of further tools able to better define and estimate bone strength and to predict the risk of fracture [1].
Objectives The aim is to assess the state of the art about Radiofrequency Echographic Multi-Spectrometry (REMS).
Methods A review of the available literature was performed, considering full papers, reviews and abstracts on REMS published before January 31th 2020.
Results REMS has been recently presented by an ESCEO consensus paper as a valuable technology for osteoporosis diagnosis and fracture risk estimation [1]. It is based on the automatic processing of the raw unfiltered signals obtained with an ultrasound scan, thus overcoming the main drawback of dual-energy X-ray absorptiometry (DXA) and computed tomography (CT)-based technologies [2]. Moreover, REMS scans are performed at axial skeleton reference sites, i.e. lumbar spine [3] and femoral neck [4], differently from quantitative ultrasound (QUS) technology, which is usually applied to peripheral sites [3]. Clinical performance has been confirmed by a multicentre clinical trial enrolling over 1900 Caucasian women, demonstrating a high correlation between bone mineral density (BMD) estimated by REMS and DXA. In addition, high performance in terms of precision and intra- and inter-operator repeatability of REMS have been assessed [6]. Prospective studies have demonstrated the predictive ability of incident fragility fractures [7] and the high concordance with DXA in terms of measured BMD in patients with rheumatoid arthritis and pre/post-menopause [8, 9].
Conclusions REMS is an innovative approach for the early diagnosis, short-term monitoring of osteoporosis and risk fracture prediction. The available data envisaged for further applications in paediatric patients, pregnant women and patients at risk of secondary osteoporosis (e.g., diabetic, nephropathic, oncological patients). The EchoS system, a device implementing the REMS technology, has recently received the approval from the U.S. Food and Drug Administration (FDA).
References 1. Diez-Perez et al. Aging Clin Exp Res 2019;31(10):1375–89 2. Iwaszkiewicz & Leszczyński. Forum Reumatol 2019;5(2):81–8 3. Hans & Baim. J Clin Densitom 2017;20(3):322-3 4. Conversano et al. Ultrasound Med Biol 2015;41:281–300 5. Casciaro et al. Ultrasound Med Biol 2016;42:1337–56 6. Di Paola et al. Osteoporos Int 2018;30:391–402 7. Adami et al. Ann Rheum Dis, vol.78, supp.2, 2019, p.A928 8. Bojincă et al. Exp Ther Med 2019;18(3):1661-68 9. Kirilova et al. Clin Cases Miner Bone Metab 2019; 16(1):14-17
Statistical Shape and Appearance Models: Development Towards Improved Osteoporosis Care