What is a ‘Fragility Score’? REMS scan results and what they mean

computerised image of backbone

Unlike traditional methods, REMS can provide a more comprehensive view of bone health by analysing both density and quality – giving you something known as a ‘Fragility Score’. We break down what this is, how it’s calculated and why it may offer a more accurate picture of fracture risk. 

Unlike traditional methods, REMS can provide a more comprehensive view of bone health by analysing both density and quality – giving you something known as a ‘Fragility Score’. We break down what this is, how it’s calculated and why it may offer a more accurate picture of fracture risk. 

How Fragility Scores are calculated

In a REMS scan, ultrasound is used to send sound waves into the bone. These waves bounce back, and get analysed by a computer to create a 3D assessment of bone architecture.

This analysis is then used to create what is known as a ‘Fragility Score’. The Fragility Score is calculated by comparing the analysis of the patients results with reference models representative of fragile or fractured and non-fragile or non-fractured bones. These reference models account for gender, age, site and body mass index to improve accuracy. Like in DEXA, a T-score is also calculated.

DEXA primarily measures bone mineral density (BMD). While this is important, it doesn’t give a full picture of bone health. For example, an 80-year-old with a T-Score of -3.0 would have a much higher risk of fracture compared to a 60-year-old with the same T-Score of -3.0 due to differences in the quality of the bone architecture. REMS goes further by also looking at bone quality, giving a more complete understanding of bone strength.

ultrasound scanner

How Fragility Scores are calculated

In a REMS scan, ultrasound is used to send sound waves into the bone. These waves bounce back, and get analysed by a computer to create a 3D assessment of bone architecture.

This analysis is then used to create what is known as a ‘Fragility Score’. The Fragility Score is calculated by comparing the analysis of the patients results with reference models representative of fragile or fractured and non-fragile or non-fractured bones. These reference models account for gender, age, site and body mass index to improve accuracy. Like in DEXA, a T-score is also calculated.

DEXA primarily measures bone mineral density (BMD). While this is important, it doesn’t give a full picture of bone health. For example, an 80-year-old with a T-Score of -3.0 would have a much higher risk of fracture compared to a 60-year-old with the same T-Score of -3.0 due to differences in the quality of the bone architecture. REMS goes further by also looking at bone quality, giving a more complete understanding of bone strength.

ultrasound scanner
REMS scan results graph showing fragility score

Understanding the Fragility Score

The Fragility Score is a number that ranges from 0 to 100. A lower score, closer to 0, indicates stronger, healthier bones. 

0-20: Low Fragility – Bones are strong and healthy and are at low risk of fracture.

21-40: Moderate Fragility – Bones are fairly strong but might show some early signs of weakness. Moderate risk of fractures. It’s a good idea to start preventive measures like diet changes and exercise.

41-60: High Fragility – Bones are weaker, with noticeable signs of reduced strength. High risk of fractures. Medical intervention may be needed.

61-100: Very High Fragility – Bones are very weak and fragile. Very high risk of fractures. Immediate medical attention is necessary.

 

To make it even easier to understand, your fragility score will be plotted on a graph, with results typically categorised into three colour-coded zones:

  • Green: Indicates a healthy bone density.
  • Yellow: Suggests a potential for bone loss and increased fracture risk.
  • Red: Indicates a high risk of osteoporosis and fractures.
REMS scan results graph showing fragility score

Understanding the Fragility Score

The Fragility Score is a number that ranges from 0 to 100. A lower score, closer to 0, indicates stronger, healthier bones. 

0-20: Low Fragility – Bones are strong and healthy and are at low risk of fracture.

21-40: Moderate Fragility – Bones are fairly strong but might show some early signs of weakness. Moderate risk of fractures. It’s a good idea to start preventive measures like diet changes and exercise.

41-60: High Fragility – Bones are weaker, with noticeable signs of reduced strength. High risk of fractures. Medical intervention may be needed.

61-100: Very High Fragility – Bones are very weak and fragile. Very high risk of fractures. Immediate medical attention is necessary.

 

To make it even easier to understand, your fragility score will be plotted on a graph, with results typically categorised into three colour-coded zones:

  • Green: Indicates a healthy bone density.
  • Yellow: Suggests a potential for bone loss and increased fracture risk.
  • Red: Indicates a high risk of osteoporosis and fractures.

Fragility Score and fracture risk

One of the standout benefits of REMS is its ability to detect smaller changes in bone health. The Fragility Score provides a more detailed and sensitive analysis, which can pick up on minor variations in bone quality that DEXA misses. 

The Fragility Score is consistently found to be an effective tool for the prediction of fracture risk over time1, with much more specificity than the T-score. REMS is therefore an advantageous diagnostic and monitoring tool for the identification and subsequent treatment of bone fragility.

man holding his leg with leg bone fracture

Fragility Score and fracture risk

One of the standout benefits of REMS is its ability to detect smaller changes in bone health. The Fragility Score provides a more detailed and sensitive analysis, which can pick up on minor variations in bone quality that DEXA misses. 

The Fragility Score is consistently found to be an effective tool for the prediction of fracture risk over time1, with much more specificity than the T-score. REMS is therefore an advantageous diagnostic and monitoring tool for the identification and subsequent treatment of bone fragility.

man holding his leg with leg bone fracture

References

  1. Ciardo D, Pisani P, Lombardi FA, et al (2021). Incident Fracture Risk Prediction Using The Fragility Score Calculated By Lumbar Spine Radiofrequency Echographic Multi Spectrometry (Rems) Scans, Annals of the Rheumatic Diseases. 80:294.

References

  1. Ciardo D, Pisani P, Lombardi FA, et al (2021). Incident Fracture Risk Prediction Using The Fragility Score Calculated By Lumbar Spine Radiofrequency Echographic Multi Spectrometry (Rems) Scans, Annals of the Rheumatic Diseases. 80:294.