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Assessing the Health of Our Bones - Part II: Bone Quality & Bone Health Measurement Tools

Updated: May 13

By Rachel Ames, MPT and Owner of Missoula OsteoStrong

What is Bone Quality and How Do We Gain It?

Bone quality is a critical factor that, along with bone quantity, determines bone strength.  Bone quality describes aspects of bone composition and structure that contribute to bone strength independently of bone mineral density. These include bone turnover, microarchitecture, mineralization, microdamage and the composition of bone matrix and mineral.

Optimal bone quality is derived from continued production of both osteoblasts and osteoclasts that work together to form new bone cells and break down old or damaged bone tissue so that we continue new healthy turnover of our bone for optimal density and quality.  As we know, osteoblast production slows significantly around age 30, so our bodies have more osteoclasts to tear down old bone that has poor quality and thus our bone quality and density begins to decline. So therefore our bodies are not regenerating/rebuilding as much as what we are breaking down, thus aging.  However, science has shown us that if we use osteogenic loading to load our musculoskeletal system with 4.2x our body weight (2012 Deere & Tobias study) we can trigger natural new bone growth. 

How Do We Know What Cells are Doing?  

You can ask your doctor to test for these Bone Turnover Markers that measure certain biomarkers or indicators of the bone health cycle. These indicators are normally noted within a few hours of your OsteoStrong Session and tell us what activity your body is doing to build new bone.  Click below to read about "Bone Turnover Markers " .

What Are Other Bone Health Testing Options? 

As we mentioned in Part I of our series, DXA scans are currently the gold standard in the industry but unfortunately DXA’s have shortfalls of inconsistencies and variability between machines and technicians.  In addition, the DXA does not provide us with information about our bone quality.

You can familiarize yourself with some new bone screening technologies that are emerging to address the deficiencies with DXA in the below handout "Emerging Bone Health Testing Technologies".

Unfortunately, we are not aware that any of these options are not currently available in our area.   However, we are excited about a quickly emerging technology that we expect to become the new gold standard for bone screening. REMS (Radiofrequency Echographic Multi Spectrometry) is a radiation-free ultrasound-based technology developed in Italy to measure BMD, bone quality and strength.  It has undergone extensive testing and is now FDA approved in the United States. REMS provides immediate results with precision, automation and analysis capabilities that are unmatched.

REMS uses unfiltered ultrasound signals to scan both hips and lumbar spine providing a T-score, a “fragility score” and data analysis with over 100,000 other patients stored in its database. For those with scoliosis, calcifications/bone spurs, and other limiting factors to DXA, REMS will improve the accuracy of the outcome of your score. 

What is the Fragility Score?

A fragility score is a REMS-based indicator for the prediction of incident fragility fractures in a 5 year time frame. The fragility score is a parameter used to estimate skeletal fragility, regardless of bone mineral density (BMD) therefore specific to REMS technology. The fragility score provides valuable information about bone quality beyond BMD measurement, and it helps assess the likelihood of fragility fractures to help with osteoporosis management. 

Echolight REMS Coming to Missoula OsteoStrong!!

REMS is expected to have a significant impact on bone health prevention and treatment.  And for this reason, we are very excited to announce that Missoula OsteoStrong will be bringing Echolight REMS to Missoula as a high quality, accurate and consistent bone health testing option. We will have more information about this technology and access to it at Missoula OsteoStrong in the coming months! 

Here are some additional resources on Echollight REMS:

  • You can learn more about Echolight REMS at

  • You can also watch this video with Dr. Doug Lucas, bone health expert, as he covers REMS Echolight giving you an understanding of how it compares to DXA and how it's testing works.  

We hope you learned something about bone quality and testing this week and are as excited about REMS Echolight as we are! Tune in next week for Part III of our educational series on “Considering Individual Factors” where we will cover what individual factors can affect our bone health. This topic is in alignment with the Strong Talk with Dr. Mike Hutchins on May 21, so be sure to mark that on your calendar and rsvp here!

As always, please bring your questions to your sessions for your session coaches!  We are here to help!  Here is a question that was submitted this week!

Your Questions Answered:

Question: How do bisphosphonates impact the quality of your bones?

Answer: As mentioned above, optimal bone quality is derived from continued production of both osteoblasts and osteoclasts that work together to form new bone cells and break down old or damaged bone tissue so that we continue new healthy turnover of our bone for optimal density and quality. Osteoblasts build new bone and osteoclasts break down old bone. Bisphosphonates simply keep bone from breaking down/remodeling in turn limiting osteoclasts and therefore resulting in lower bone quality by allowing new bone to build onto older unhealthy bone.



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