Radiofrequency Echographic Multispectrometry (REMS) as a Potentially Useful Device for Assessing Lumbar Bone Mineral Density in Patients with CKD

Background: Low bone mineral density (BMD) is a known risk factor for fragility fractures among patients with chronic kidney disease (CKD). Dual-energy X-ray absorptiometry (DXA) is currently the standard method for assessing BMD. However, the reliability of lumbar spine DXA in CKD patients has been questioned. Radiofrequency Echographic Multi-spectrometry (REMS) is an ultrasound-based bone assessment system. Since REMS involves operator-guided probe placement and algorithm-based selection of valid ultrasonic signals, it can exclude data from severely deformed vertebrae and is unaffected by calcified abdominal aorta. Methods: We enrolled adult patients with CKD undergoing maintenance hemodialysis at Yurin Hospital who had undergone both DXA and abdominal computed tomography (CT) as part of routine care and provided informed consent for REMS （EchoStation, Echolight Spa, Lecce, Italy）assessment. Results: A total of 25 patients (16 men, 9 women; mean age 69.9 ± 12.1 years; dialysis duration 102.2 ± 70.4 months; 11 with diabetes) were included in the analysis. The T-score of L1–L4 measured by DXA (LT-DXA) significantly correlated with the T-score at the hip (HT-DXA), but showed no significant correlation with Hounsfield units or the lumbar T-score measured by REMS (LT-REMS). LT-DXA values were significantly higher than that of LT-REMS (P < 0.0001). LT-REMS strongly correlated with HT-REMS (r2>= 0.759, P < 0.0000001), and showed a weak correlation with Hounsfield units (r2 = 0.179, P < 0.05). While the discrepancy between LT-DXA and LT-REMS tended to be associated with the number of vertebral compression fractures and abdominal aortic calcification score, neither was a definitive determinant. Conclusion: REMS has the potential to be a more useful and reliable device than DXA for assessing lumbar spine BMD in patients with CKD. Notably, in two patients who could not be diagnosed with osteoporosis based on LT-DXA but met diagnostic criteria based on LT-REMS, fragility fractures developed during the observation period. Funding: Clinical Revenue Support