Abstract
Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology for the densitometric assessment of osteoporosis. It has already been validated in Italian women with respect to the current clinical reference technology, Dual-energy X-ray Absorptiometry (DXA). Aim of the current study was to assess the diagnostic accuracy of REMS technology with respect to DXA in a wider European clinical context. A total of 4307 female Caucasian patients aged between 30 and 90years underwent DXA and REMS scans at femoral neck and/or lumbar spine (the site depending on the medical prescription). The acquired data underwent a rigorous quality check in order to exclude the erroneous DXA and REMS reports. The diagnostic agreement between the two technologies was assessed, also stratifying for patients' age groups. The ability to recognise previously fractured patients was also investigated. Overall, 4245 lumbar spine scans and 4271 femoral neck scans were performed. The ability to discriminate patients with and without osteoporosis by femoral neck investigation resulted in sensitivity and specificity of 90.4% and 95.5%, respectively. For lumbar spine scans, a sensitivity of 90.9% and a specificity of 95.1% were obtained. The areas under the curve (AUCs) of the Receiver Operating Characteristic (ROC) curve evaluating the ability to discriminate groups of patients with previous osteoporotic fracture using DXA and REMS T-score values were 0.631 and 0.683 (p<0.0001), respectively, for femoral neck scans, whereas 0.603 and 0.640 (p=0.0002), respectively, for lumbar spine scans. The diagnostic effectiveness of REMS technology at reference anatomical sites for the assessment of osteoporosis has been confirmed in a large series of female patients, spanning from younger and pre-menopausal to elderly women up to 90years, in a multicenter European clinical context.
Highlights
Osteoporosis, a bone metabolic disease characterized by low bone mass and by alterations of macro- and micro-architecture of the skeletal tissue, is the main cause of fractures occurring over the age of 50 years as a result of non-traumatic injuries or low/medium energy traumas, commonly known as fragility fractures [1,2].Over the last decades, the conception of this condition has evolved from being considered as an inevitable consequence of ageing to being recognised as a serious and treatable disease [3]
With the exclusion of 340 (8.0%) and 408 (9.6%) erroneous Dual-energy X-ray Absorptiometry (DXA) reports for femoral neck and lumbar spine, respectively, and of 323 (7.6%) and 373 (8.8%) erroneous Radiofrequency Echographic Multi Spectrometry (REMS) scans for femoral neck and lumbar spine, respectively, 3608 femoral neck and 3464 lumbar spine cases, respectively, were subse quently used for the clinical performance analysis
The reported Positive predictive value (PPV) values, in particular, might be explained with the findings of a recent prospective study by Adami et al [16], which investigated the ability of REMS and DXA T-score to identify patients prone to incident fragility fractures: this study showed the increased performance of REMS with respect to DXA when the clinical endpoint is considered, as demonstrated by the higher area under the curve (AUC) of REMS T-score values than DXA ones obtained for the discrimination between cases with and without incident fragility fracture
Summary
Osteoporosis, a bone metabolic disease characterized by low bone mass and by alterations of macro- and micro-architecture of the skeletal tissue, is the main cause of fractures occurring over the age of 50 years as a result of non-traumatic injuries or low/medium energy traumas, commonly known as fragility fractures [1,2].Over the last decades, the conception of this condition has evolved from being considered as an inevitable consequence of ageing to being recognised as a serious and treatable disease [3]. Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology for the densitometric assessment of osteoporosis It has already been validated in Italian women with respect to the current clinical reference technology, Dual-energy X-ray Absorptiometry (DXA). The areas under the curve (AUCs) of the Receiver Operating Characteristic (ROC) curve evaluating the ability to discriminate groups of patients with previous osteoporotic fracture using DXA and REMS T-score values were 0.631 and 0.683 (p < 0.0001), respectively, for femoral neck scans, whereas 0.603 and 0.640 (p = 0.0002), respectively, for lumbar spine scans. Conclusion: The diagnostic effectiveness of REMS technology at reference anatomical sites for the assessment of osteoporosis has been confirmed in a large series of female patients, spanning from younger and pre-menopausal to elderly women up to 90 years, in a multicenter European clinical context
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