Research Square · Oct 18, 2026
Role of REMS fracture risk prediction within the DVO-based fracture risk framework: a retrospective observational study
By Kurth A, Baron J, Baron J
Background The 2023 German DVO guidelines introduced a risk-adapted osteoporosis management based on 3-year fracture risk, integrating DXA-T-scores with demographic, anthropometric and clinical risk factors. Within this framework, Radiofrequency Echographic Multi-Spectrometry (REMS), a radiation-free ultrasound-based technology providing densitometric parameters, Fragility Score (FS), and 5-year fracture risk stratification, may offer complementary skeletal information relevant to DVO-based assessment. Aim To compare DXA-DVO 2023 risk categories with exploratory REMS-DVO-equivalent categories, and to evaluate the relationships of REMS-DVO categories with FS and REMS 5-year fracture risk classes. Methods This retrospective observational study included 256 patients who underwent paired DXA and REMS examinations (n = 128 per site). DVO 2023 risk categories were calculated using DXA-T-scores and compared with estimates obtained by REMS-T-scores while keeping all other factors unchanged. Agreement was assessed using percentage agreement and weighted Cohen’s kappa before and after applying a ± 0.3 tolerance at T-score thresholds. Internal coherence with FS and 5-year fracture risk categories was evaluated across DVO categories by Kruskal-Wallis followed by Wilcoxon tests with false discovery rate correction. Results DXA-based and REMS-substituted DVO categories showed high agreement at both sites: 81.2% (κ = 0.84) at the femur and 80.5% (κ = 0.85) at the spine. After ± 0.3 tolerance, agreement increased to 86.7% (κ = 0.87) and 83.6% (κ = 0.87), respectively. FS progressively increased across higher DVO risk categories, while REMS 5-year fracture risk classes shifted toward higher-risk categories with increasing DVO thresholds. Conclusions REMS-derived parameters showed substantial coherence with DVO risk groups, supporting REMS technology as a valuable tool allowing a timely indication for intervention and preventive strategies.