REMS (Radiofrequency Echographic Multi-Spectrometry) is an ultrasound-based alternative to DEXA that avoids radiation and is gaining attention for osteoporosis screening. A 2026 study in Osteoporosis International found that more than 90% of the variance in REMS bone density scores was explained by entered demographics (age, weight, height, sex), not direct skeletal measurement - and that back-to-back scans on the same person shifted by roughly 4.3% when researchers changed only the entered weight by 5 kg. That is a serious problem if your goal is to know whether your bones are truly improving. REMS may still have a role in screening or where DEXA access is limited, but for tracking bone density over time, DEXA remains the validated clinical standard. This article explains the new evidence, what it means for women comparing scans, and why we still recommend DEXA at OsteoStrong.
Over the last several years, there has been growing excitement around a newer bone scanning technology called REMS, short for Radiofrequency Echographic Multi-Spectrometry.
Unlike DEXA, REMS uses ultrasound instead of low-dose X-rays to estimate bone density and fracture risk. The promise sounded compelling:
- No radiation
- Portable technology
- Faster scans
- Potentially lower cost
- Easier access to bone health testing
For many people, especially those concerned about osteoporosis, this sounded like the future of bone health assessment.
But recently, serious concerns have emerged about how reliable REMS scans actually are when used to compare bone density over time.
And that matters.
Because if you are trying to answer the question:
Are my bones actually improving?
…the scan has to be able to accurately detect real skeletal change, not simply shift based on age, weight, or algorithmic assumptions.
If you already have a DEXA in hand and the numbers look confusing, start with Understanding Your DEXA T-Score before you compare any follow-up scan.
The problem emerging with REMS
A recently published study in Osteoporosis International raised significant concerns about how REMS calculates bone density results.
Researchers found that REMS outputs appeared to be driven primarily by demographic inputs such as:
- Age
- Weight
- Height
- Sex
…rather than direct skeletal measurement.
In fact, the study found that demographic data alone explained more than 90% of the variation in REMS bone density scores in their clinical cohort.
Even more concerning, researchers artificially changed the entered age and weight of volunteers while the person's actual skeleton obviously remained unchanged.
The REMS results still shifted dramatically.
The >90% figure comes from a same-cohort analysis and is debated - the manufacturer's own follow-up puts it lower. We cover that methodology debate in the June 2026 update below; either way, demographics drive the majority of the score.
The experimental findings included:
- Increasing entered age lowered femoral neck REMS bone mineral density by roughly 6.3% per decade
- Increasing entered weight by 5 kg (11 pounds) increased femoral neck REMS bone mineral density by roughly 4.3%
The authors concluded that REMS output reflects an assessment strongly based on demographic parameters rather than ultrasound-based direct skeletal measurement alone, and urged caution for individual assessment, use alongside FRAX, and longitudinal monitoring.
A bone scan should measure your bones. These findings suggest a large share of your REMS number actually comes from the age and weight entered into the machine - not the ultrasound looking at your skeleton. That can be fine for a one-time estimate, but it becomes a problem the moment you try to compare two scans over time.
A major red flag: back-to-back scans changed by entering different weight
One of the most concerning findings involved what happened when researchers performed back-to-back scans on the exact same person.
The person's skeleton did not change.
The scan happened immediately afterward.
The only thing researchers changed was the entered demographic information - specifically, the person's entered weight.
And the REMS bone density result changed significantly.
According to the study, increasing entered weight by just 5 kg (11 pounds) increased REMS bone mineral density results by approximately 4.3%.
That is a massive concern.
Because bone density does not suddenly increase 4% moments later simply because someone typed in a different body weight.
The skeleton itself did not biologically change.
The person did not suddenly build new bone tissue in the span of a few minutes.
Yet the scan result changed anyway.
The obvious follow-up question becomes:
If gaining 10 pounds artificially increases the REMS score, what happens when someone loses 10 pounds?
Would the scan now suggest they lost bone density even if their skeleton stayed exactly the same?
That is the concern.
These changes are artificial algorithmic shifts, not true biological skeletal changes.
And that becomes extremely problematic when using scans to monitor progress over time.
It is also worth noting how this was tested: the same person, scanned repeatedly, with only the entered data changed. That is not an abstract population study - it mirrors exactly how you would be tracked in real life, as one individual returning for follow-up scans. A small, controlled test like this is built to isolate cause and effect, which is precisely what you need to see whether the machine, not the skeleton, is what moved the number.
Many adults experience weight fluctuations due to:
- Dieting
- GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound)
- Illness
- Exercise programs
- Menopause
- Aging
- Muscle gain or fat loss
If those weight changes can significantly alter the reported REMS bone density result independent of the actual skeleton, it raises serious questions about whether the technology can reliably track true bone change longitudinally.
To be clear, this is a separate issue from the real bone loss that can accompany weight loss in sedentary adults - that is well documented. (It is also why staying mechanically active matters: weight-bearing and resistance exercise during weight loss has been shown to attenuate the bone loss that dieting alone can cause.) The concern here is narrower: in the back-to-back test, the body did not change at all - only the number typed into the machine did - so the shift in the result was purely algorithmic, not biological.
This is one of the primary reasons the authors urged caution when using REMS for monitoring bone density trends over time.
Your weight rarely stays identical between scans - and neither does your age. If a few pounds or another birthday can move the REMS number on their own, a small year-over-year change is hard to trust as real bone gain or loss. That is the whole problem with using it to track progress.
Why this matters
Most people getting bone scans are not simply looking for a rough estimate of fracture risk.
They want to know:
- Did I improve?
- Did I lose bone?
- Is my treatment working?
- Is my exercise program helping?
- Is my nutrition making a difference?
If a scan is heavily influenced by demographic modeling, weight changes, or algorithmic assumptions, it becomes much harder to know whether the change on paper reflects a true biological change in bone.
That is the core concern now being discussed in the bone health community.
If your physician has already framed your risk with a FRAX score, remember that FRAX itself incorporates age, sex, weight, and your femoral neck T-score - see Lowering Your FRAX Fracture Risk Without Medication for how DEXA improvements at the hip can move that number when the underlying measurement is trustworthy.
Does this mean REMS is completely useless?
No.
REMS may still have value as:
- A screening tool
- A fracture risk estimation tool
- An option in locations where DEXA access is limited
- A supplemental assessment alongside other clinical information
It is worth being precise about what REMS has actually been validated for. The published agreement with DEXA is largely for a single, one-time scan - and even that agreement is a population average across many people. What is missing is published evidence that REMS can reliably measure change in the same person over time; the recent critique noted only a single preliminary conference abstract on that question. Strong agreement on one baseline scan does not establish that follow-up scans can be trusted - and based on what these studies show about demographic weighting, the follow-up is exactly where the problems would surface.
So based on the current evidence, there are legitimate concerns about using REMS as the primary method for tracking bone density changes over time.
Especially when important health decisions are being made based on those results.
Why DEXA still remains the gold standard
DEXA is not perfect.
No imaging technology is.
DEXA scans can be affected by:
- Poor positioning
- Machine calibration differences
- Osteoarthritis
- Degenerative spinal changes
- Technician inconsistency
- Comparing scans from different facilities
But there are two important differences.
First, DEXA's actual measurement does not depend on your demographics. This is the crux. A DEXA reports bone mineral density as a physical value in grams per square centimeter (g/cm²), measured directly from X-ray attenuation. That number does not change because of your entered age or weight. Demographics only enter when that BMD is converted to a T-score (your comparison to a young-adult reference population). For tracking change over time, the standard is to compare the raw g/cm² - the demographic-free physical measurement - not the T-score. That is the opposite of the concern raised about REMS, where the BMD output itself appears to be demographically weighted before you ever interpret it.
Second, the limitations of DEXA are well understood.
Over decades, the bone health industry has developed protocols to reduce these issues and improve accuracy.
Today, high-quality DEXA facilities commonly account for:
- Least Significant Change (LSC) - the smallest real change that machine can reliably detect
- Same-machine comparisons for follow-up scans
- Calibration standards
- Proper patient positioning
- Comparing image regions directly
- Consistent scanning protocols over time
Patients themselves are also becoming more educated about how to properly compare scans.
That matters because when bone density changes are small, precision matters. A 2% spine gain on a follow-up DEXA only means something if you know the measurement is real - which is why our member outcomes are tied to verified scan reports, not self-reported feelings alone.
If you are new to the labels on your report, Osteopenia vs. Osteoporosis explains the difference between low bone mass and the osteoporosis diagnosis threshold.
DEXA is not flawless, but its weak spots are known and managed - same machine, consistent positioning, and a clear threshold (least significant change) for what counts as a real difference. That is exactly what lets you believe a follow-up gain instead of guessing whether the number just drifted.
Why we recommend DEXA at OsteoStrong
At OsteoStrong, our goal is simple:
We want the most reliable way possible to measure whether someone is truly improving over time.
Based on the current evidence, DEXA remains the most validated and clinically trusted method for longitudinal bone density tracking.
That is why we currently recommend DEXA scans for comparing bone scans over time.
Not because DEXA is flawless.
But because:
- Its strengths and weaknesses are well understood
- Its measurement principles are transparent
- Its protocols continue improving
- And it remains the clinical standard used worldwide for monitoring real skeletal change
Our position is not that DEXA is perfect.
It is that DEXA's limitations are measurable, understood, and actively managed through established protocols.
In contrast, the recent REMS publication raises important questions about whether demographic assumptions may substantially influence reported changes over time.
Until those questions are fully resolved, we believe DEXA remains the most reliable tool for monitoring bone density trends.
When members do see gains, they often show up on follow-up DEXA after consistent weekly osteogenic loading - the mechanical signal your skeleton uses to rebuild. Reversing Osteoporosis: What Women Over 50 Actually Accomplish documents verified Austin and Georgetown outcomes for context on what is possible when the measurement and the protocol both stay consistent.
Update (June 2026): New research from Echolight - and why we still recommend DEXA for tracking
New papers from Echolight argue REMS isn't purely a demographic calculator - and they have a fair point. But even their own analysis shows age and weight still drive the majority of the score, and none of this research answers the question that matters to you: can REMS detect a small, real change in your bones over a year? For that, we still recommend DEXA.
Since this article was first published, Echolight researchers have released additional research examining how REMS calculates bone mineral density (BMD) and how demographic factors such as age and body weight influence the final result.
Two recent papers - Conversano et al. (2026) and the foundational Casciaro et al. (2016) - push back on that interpretation. Analyzing 16,000 scans, the authors argue that age and weight alone do not fully predict REMS-BMD: under independent testing, those factors left 30-43% of the variation unexplained, which they say reflects a real contribution from the ultrasound measurement itself.
It is worth understanding why their figure differs from the >90% cited above. The earlier critique fit its prediction formula and tested it on the same group of people, which inflates the apparent demographic dependence. Echolight's analysis fit the formula on one group and tested it on a separate, independent group - a more conservative method that produced a lower number. Tellingly, when Echolight applied the same-group method, their own result climbed back to roughly 90% at the femoral neck. So the two camps do not really disagree about the data; they disagree about which testing method is fairer.
Here is what matters for our members: whichever number you accept, demographic inputs explain the majority of a REMS score. Even in Echolight's own, more favorable analysis, age and weight still account for 57-70% of the result. The debate is over how dominant demographics are - not whether they dominate.
We think this is an important finding, and we take it seriously.
But we believe these papers answer a different question than the one most OsteoStrong members are asking.
Population prediction vs. individual tracking
The Echolight papers primarily evaluate how well age and weight can predict REMS results across thousands of individuals.
Our concern is different:
Can REMS reliably measure a small change in bone density in the same person over time?
For example:
- A member completes a year of OsteoStrong.
- Their body weight changes.
- Their age increases by one year.
- Their REMS score improves by 3-5%.
How much of that change represents true biological improvement in bone, and how much reflects changes in the demographic inputs used by the algorithm? That is the key question for longitudinal tracking.
This is not hypothetical. Because the REMS algorithm is anchored to entered age - the original critique found femoral neck REMS-BMD fell about 6.3% for every decade of age entered - simply being a year older at your follow-up scan can shift the result before any real change in your bones is considered. A genuine 3-5% gain from a year of training has to be separated from those built-in demographic shifts, and REMS does not yet have a published precision standard for doing that.
What this means for your scan, in plain English
If the numbers above made your eyes glaze over, here is the part that actually matters for you.
A REMS scan doesn't read your bones in isolation. Before it shows a result, it factors in your age, weight, and height - and those details have a large influence on the number you get. That creates two practical problems when your goal is to track progress over time:
- Your score can change even when your bones don't. In testing, entering a different weight or age changed the result on the same person, minutes apart, with no biological change at all. Lose 10 pounds before your next scan and the number can dip; gain weight and it can rise - even if your skeleton is exactly the same.
- A year of normal life moves the number on its own. You are a year older at every follow-up. Because age is built into the calculation, that alone can shift your score before anyone asks whether your bones actually got stronger.
So if your REMS result improves 3-5% after a year, it is genuinely hard to tell how much is real bone gain and how much is just the formula reacting to a new weight or another birthday.
DEXA works differently in one way that matters: its number comes from a direct measurement, and the field has spent decades building rules for separating a real change from normal noise - the "least significant change" we keep mentioning. When your DEXA clears that bar, you can trust it.
None of this means REMS is useless. It may be fine for a first look, or where DEXA is not available. But for the one question most members care about - "Are my bones actually getting stronger?" - you want the tool built to answer it for you, the individual, not for a population average. Today, that is still DEXA.
Our position
REMS is an innovative technology with promising applications, and it continues to be studied around the world.
After reviewing both the criticisms of REMS and Echolight's published responses, we still believe DEXA remains the most established and clinically accepted method for monitoring bone density changes over time.
For members who want to track progress as accurately as possible, we continue to recommend:
- A baseline DEXA scan
- A follow-up DEXA scan on the same machine whenever possible
- Consistent positioning and testing protocols
- Interpretation using established Least Significant Change (LSC) standards
Until similar longitudinal precision standards are clearly established for REMS, DEXA remains our preferred method for tracking bone density changes over time.
What to do before your next scan
Three practical steps:
- Keep follow-up DEXAs on the same machine at the same facility when possible. Ask for the LSC for that scanner and whether your change exceeds it.
- Bring prior reports to every appointment. Compare spine, total hip, and femoral neck separately - they do not always move together.
- If you are building bone on purpose, pair the scan with a loading plan. DEXA tells you whether the skeleton responded; How OsteoStrong Works explains the 15-minute weekly protocol we use to deliver the load signal.
If you have a DEXA (or are scheduling one) and want a second set of eyes before you commit to a long-term plan, book a free Bone Health Roadmap Call. A certified coach will review your numbers honestly and tell you whether OsteoStrong is the right fit.
In the interest of transparency: we are not a neutral party. We help people build bone, so we care a great deal about having a measurement you can trust over time. But we do not sell or operate DEXA scanners - when a member needs one, we refer them to an independent imaging facility, and we do not profit from the scan you choose. Our only interest is that the number you compare year over year actually reflects your bones.
This article is for general education and is not medical advice. Imaging choices, screening intervals, and treatment decisions belong between you and your physician. If you have had both REMS and DEXA, discuss discordant results with the clinician who ordered the scans.
References
- Chan D, Chen W, Yabsley E, et al. Demographic determinants of REMS-derived BMD and fragility score. Osteoporosis International. 2026. doi:10.1007/s00198-026-07960-4.
- Reginster JY, et al. Radiofrequency echographic multi spectrometry (REMS) in the diagnosis and management of osteoporosis: state of the art. Aging Clinical and Experimental Research. 2024;36:135. doi:10.1007/s40520-024-02784-w. (ESCEO working-group synthesis on REMS clinical deployment; published before the 2026 demographic-determinants findings.)
- Zibellini J, Seimon RV, Lee CM, et al. Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials. Journal of Bone and Mineral Research. 2015;30(12):2168-2178. doi:10.1002/jbmr.2564. (Context for why weight change and longitudinal bone measurement must be interpreted carefully.)
- Conversano F, Pisani P, Casciaro S. Methodological Clarification and Analysis of Demographic and Anthropometric Determinants in the Calculation of REMS Bone Mineral Density. Calcified Tissue International. 2026;117:85. doi:10.1007/s00223-026-01547-1. (Echolight researchers' analysis of 16,000 scans; argues age and weight leave 30-43% of REMS-BMD variance unexplained under independent testing, so patient-specific ultrasound data contributes meaningfully to the result.)
- Casciaro S, Peccarisi M, Pisani P, et al. An Advanced Quantitative Echosound Methodology for Femoral Neck Densitometry. Ultrasound in Medicine & Biology. 2016;42(6):1337-1356. doi:10.1016/j.ultrasmedbio.2016.01.024. (Foundational validation of the REMS/echosound femoral-neck method against DEXA, with r-squared up to 0.79.)
- Villareal DT, Aguirre L, Gurney AB, et al. Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults. New England Journal of Medicine. 2017;376(20):1943-1955. doi:10.1056/NEJMoa1616338. (During weight loss, adding resistance/weight-bearing exercise attenuated the loss of bone mineral density seen with dieting alone.)
Your simple plan from here
- Book your free Bone Health Call. 15 minutes, phone or Zoom, no pressure.
- Come in for a guided first session. A coach walks you through all four devices.
- Track your strength week after week. 15 minutes, once a week. The numbers rise.
Frequently asked questions
Is OsteoStrong safe if I already have osteoporosis?
We hear this one a lot, and the honest answer is that a new osteoporosis diagnosis is exactly why most of our members walked in. You stay in complete control the entire session - the devices don't move, you push against a fixed resistance, and a certified coach is beside you cueing every breath. More than 100 Austin-area physicians refer patients here, including women with severe DEXA results. The safest next step is simply to talk to us. Book your free 15-minute Bone Health Call and we'll walk through your DEXA together.
Can I really build bone density at my age?
Yes, and the question tells us you already suspected the answer. Bone is living tissue that responds to a specific mechanical signal at any age. Our members in their 70s, 80s, and 90s routinely see measurable DEXA improvements, and 8 out of 10 who follow the weekly protocol see bone density gains on follow-up scans. If your doctor has told you 'it's just age,' that's half the story. The best way to find out what's possible for your body is a free Bone Health Call.
What actually happens during a session?
Most women show up nervous and leave surprised at how simple it was. You arrive in street clothes, meet your coach, and walk through four supported devices that produce the exact force your bones need to rebuild. Total time: about 15 minutes. No cardio. No sweat. No locker room. You never change clothes. Most members come on their lunch break.
Do I really only need to come once a week?
Yes, and we know that sounds too easy to be real. When your body receives the osteogenic-loading signal, it keeps rebuilding for 7 to 10 days afterward. More frequent sessions don't produce more results - consistency, once a week, is what creates lasting change. This is the whole reason this method works for women over 50 who do not want a gym routine.
How is this different from going to the gym?
A regular gym trains muscles, which is wonderful but doesn't move the needle on bone. Research suggests bone only rebuilds when it receives roughly 4.2 times your body weight in force - a level you cannot safely produce with free weights, yoga, or Pilates. OsteoStrong's devices let your body generate that precise force safely, in four short efforts, in 15 minutes. Same room. Same coach. Every week.
What does it cost?
We know price is on your mind, and we respect that. We don't post pricing online because memberships vary by location and household (individual, couple, family). Your free 15-minute call covers pricing, location options, and any questions about your specific situation - no sales pressure, no long form to fill out in between.
Will my doctor approve?
Most do. Over 100 Austin-area physicians already refer patients to us, and we're glad to send educational materials to yours. We always recommend sharing your DEXA results with us so we can track your progress alongside your physician's plan. If it helps your decision, ask your doctor what she thinks of osteogenic loading - and then book your free call.
What if I've never exercised?
You are exactly who this was built for. Most of our members aren't athletes. You do not need to be fit, flexible, or experienced, and you will not be asked to do anything your body cannot do. A certified coach is beside you every session, adjusting everything to you. If you've been avoiding gyms for 30 years, this is the place you don't have to.
Do I have to sign a long contract?
No surprises here. We offer month-to-month and longer memberships, and the pros and cons of each are walked through on your free call. We'll never pressure you into a commitment that doesn't fit your situation.
How soon will I feel a difference?
Most members notice improvements in energy, balance, and posture within the first 4 to 6 weeks - long before any DEXA change. On DEXA, the typical pattern is a halt of bone loss in year one with measurable density gains showing up in year two. Bone remodels slowly. We plan the journey in years, not months, and your weekly force-output numbers give you something to watch in the meantime.
How does OsteoStrong help with osteoporosis?
Osteoporosis means your bones have lost enough mineral that a simple fall can become a fracture. OsteoStrong adds the one thing your body cannot get from medication alone: the mechanical signal that tells bone to rebuild. Four devices, 15 minutes a week, and a coach who has seen hundreds of women in your exact spot. The best first step is a free Bone Health Call where we look at your DEXA together.
Is OsteoStrong a replacement for my osteoporosis medication?
No - we're not here to replace your doctor or your prescriptions. We're here to give you a simple weekly routine that supports your bone health alongside your medical plan. Some members, after sustained DEXA gains, have worked with their physician to taper or discontinue medications. That decision is always between you and your doctor, never between you and us.
Is OsteoStrong right for postmenopausal women?
It's built for you. Postmenopausal women are our largest group of members, because menopause is when bone loss accelerates and estrogen protection drops. Osteogenic loading delivers the signal your body needs without the high-impact movement that menopausal joints often cannot tolerate. If that sounds like the season you're in, book your free call.
Does insurance cover OsteoStrong?
Usually not, and we'll give you the straight answer: OsteoStrong is a wellness service, not a medical treatment, so most U.S. insurance plans don't cover it. Some members use HSA or FSA funds. Your free Bone Health Call covers pricing and payment options for your specific situation.
How is OsteoStrong different from physical therapy or the gym?
Physical therapy is medical rehabilitation and usually ends when you've recovered. A gym provides general exercise but rarely reaches the force threshold associated with bone rebuilding. OsteoStrong is a single-purpose service focused on triggering the osteogenic-loading signal. One coach, four devices, 15 minutes, once a week, indefinitely. Many of our members keep their PT or their gym and simply add OsteoStrong for bone health.
What happens if I don't do anything about bone loss?
This is the question we wish more women asked, and we'll give you a gentle but honest answer. Bone loss is quiet. It compounds year after year until a simple trip becomes a fracture. One in two women over 50 will break a bone because of osteoporosis in her lifetime. Forty percent of hip-fracture patients lose the ability to live independently, and nearly one in four dies within a year. Those are the stakes. The good news: the next step is small, it's free, and it's a 15-minute phone call. Book your free Bone Health Call - we'll meet you where you are.
I'm scared. What should I do first?
Of course you are. Bone loss is a quiet thing that suddenly becomes very loud at a doctor's appointment, and no one sat with you and walked through what comes next. Start with the smallest, safest step: book a free 15-minute Bone Health Call. It's a phone or Zoom conversation with someone who has helped hundreds of women in your exact situation. We'll read your DEXA with you, answer your questions, and help you decide whether to come in. You don't commit to anything. You just get a real person to talk to.
What is REMS?
REMS stands for Radiofrequency Echographic Multi-Spectrometry. It is a newer bone assessment technology that uses ultrasound instead of the low-dose X-rays used in DEXA (dual-energy X-ray absorptiometry). REMS estimates bone mineral density and a proprietary fragility score at sites such as the femoral neck and lumbar spine. It is often marketed as radiation-free, portable, and faster than traditional DEXA.
Can REMS replace DEXA for monitoring bone density?
Based on current evidence, we do not recommend using REMS as your primary method for comparing bone density over time. A 2026 study in Osteoporosis International found that REMS outputs were strongly driven by entered demographic data (age, weight, height, sex) rather than direct skeletal measurement, with back-to-back scans on the same person shifting when only the entered weight changed. DEXA remains the clinical standard for longitudinal tracking because its limitations are well understood and managed with established protocols such as least significant change (LSC) and same-machine comparisons.
Why would a REMS score change if my skeleton did not?
The 2026 Chan et al. study reported that demographic inputs alone explained more than 90% of the variance in REMS bone density scores in their clinical cohort. In a controlled experiment, researchers changed only the entered age and weight while scanning the same person back-to-back. Increasing entered age lowered femoral neck REMS-BMD by roughly 6.3% per decade; increasing entered weight by 5 kg (about 11 pounds) raised femoral neck REMS-BMD by roughly 4.3%, with no biological change to the skeleton in between. That is an algorithmic shift, not a true bone-density change.
Is DEXA radiation a reason to choose REMS instead?
DEXA uses a very small dose of radiation - typically less than a day of natural background exposure for a hip and spine scan. For most adults, especially postmenopausal women who need repeatable baseline and follow-up scans, that dose is considered acceptable relative to the clinical value of a validated longitudinal measurement. REMS avoids radiation, which may matter for specific situations, but the trade-off for monitoring over time is measurement reliability, which is what the recent REMS research calls into question.
What is least significant change (LSC) on a DEXA?
Least significant change is the smallest bone density difference a given DEXA machine and facility can reliably detect between two scans on the same person. If your follow-up change is smaller than the LSC, it may be noise from positioning, calibration, or normal variability rather than a real gain or loss. High-quality bone density centers report LSC values and compare follow-up scans on the same machine with consistent positioning - which is why we tell members to keep their DEXA at the same facility when possible.
Does OsteoStrong require a DEXA before starting?
We strongly recommend a recent DEXA if you are concerned about bone density, osteopenia, or osteoporosis. On a free Bone Health Roadmap Call, a certified coach can review your report with you and discuss whether osteogenic loading is a fit. We track strength at the center week to week; your DEXA is the independent check on whether your skeleton is responding over months and years.
Doesn't Echolight's own research show REMS isn't just a demographic calculator?
Echolight researchers have published an analysis of 16,000 scans arguing that age and weight alone leave 30-43% of REMS bone density variance unexplained, meaning patient-specific ultrasound data does contribute to the result. We agree that is an important finding. But it answers a population-prediction question - how well demographics predict REMS across thousands of people - not the longitudinal question that matters to members: can REMS reliably detect a small change in the same person over time? Until longitudinal precision standards (like DEXA's least significant change) are established for REMS, we still recommend DEXA for tracking bone density changes over time.
