The Dr. Doug Show The REMS Fragility Score: A Better Predictor Than T-Score Alone [Dr. Nick Birch Interview]
Dec 10, 2025
Dr. Nick Birch, an orthopedic spine surgeon with over 35 years of expertise, dives into the limitations of the T-score in predicting fracture risk. He introduces REMS imaging, emphasizing its ability to measure bone toughness and provide a more accurate fragility score. Their discussion highlights how relying solely on T-scores can lead to unnecessary fear and misdiagnosis, impacting quality of life. Birch also addresses the promising trajectory for REMS adoption, its clinical value, and encourages a proactive approach to bone health for patients.
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REMS Sees Bone Differently
- REMS uses ultrasound backscatter to assess bone density and bone toughness, unlike DEXA's surface X-ray measurement.
- This gives a more complete picture of bone quality and removes some operator variability present in DEXA.
Ultrasound Technologies Will Rise Gradually
- REMS and other ultrasound methods are likely to grow as patients prefer non-radiation, repeatable tests.
- DEXA infrastructure and familiarity will slow adoption, so change will be gradual.
Pseudo-3D Bone Assessment
- REMS analyzes reflected ultrasound patterns correlated with micro-CT to infer 3D bone structure.
- That makes REMS a pseudo–three-dimensional assessment closer to CT than to DEXA.
