Ultrasound bone densitometry with REMS in patients with chronic kidney disease

Abstract

Osteoporosis is a systemic disease characterized by reduced bone mass and deterioration of bone microarchitecture, leading to decreased bone strength and an increased risk of fragility fractures. Diagnosis is primarily based on bone mineral density (BMD), defined by the World Health Organization as a value ≤ −2.5 standard deviations below the young adult reference population, as measured by dual-energy X-ray absorptiometry (DXA), currently considered the gold standard. However, DXA has limitations in assessing bone quality and microarchitecture, both of which are crucial for fracture risk evaluation. In chronic kidney disease, osteoporosis occurs within the spectrum of renal osteodystrophy, where abnormalities in bone turnover may present as either high- or low-turnover disease, further increasing the risk of fractures at typical skeletal sites. In addition to conventional assessment tools, complementary methods such as FRAX, trabecular bone score (TBS), quantitative computed tomography (QCT), and quantitative ultrasound (QUS) have been developed, although each has specific clinical limitations. Radiofrequency Echographic Multi Spectrometry (REMS) is an innovative ultrasound-based technique that enables non-invasive assessment of BMD and bone microarchitecture without ionizing radiation. It has shown a high correlation with DXA and may be particularly valuable in patients with chronic kidney disease, including those with vascular calcifications.