Bone loss is one of the most predictable surprises in medicine.
It is predictable because the risk factors are everywhere: menopause, aging, low muscle, low protein intake, steroid exposure, inflammatory disease, low sex hormones, diabetes, smoking, alcohol, thyroid disease, malabsorption, kidney disease, eating disorders, and medications that quietly affect bone. It is a surprise because many patients do not know there is a problem until something breaks. That is not prevention. That is damage control.
DEXA has been the standard bone density tool for decades, and it remains important. It is widely available, familiar to clinicians, and embedded in guidelines. But a prevention-focused practice should ask a bigger question: Are we finding bone risk early enough?
Many patients are not tested until late. Many men are missed. Many perimenopausal women are told to wait. Many younger patients with clear risk factors are ignored because they do not fit the usual age-based screening box. Many patients are tested once, then told to come back years later, even while their hormones, medications, nutrition, weight, or inflammatory disease are changing.
This is why ultrasound-based REMS technology deserves more attention.
REMS, or Radiofrequency Echographic Multi Spectrometry, is a non-ionizing ultrasound-based method for assessing bone health at axial skeletal sites such as the lumbar spine and femoral neck. It can be performed in a physician office without a special lead room. REMS can provide bone-density related information, T-score and Z-score reporting, and a Fragility Score that attempts to capture skeletal fragility beyond density alone.
The point is not to create a false war between DEXA and REMS. The point is to expand the prevention conversation.
Published reviews report strong diagnostic agreement between REMS and DEXA in several populations, good precision and repeatability, and potential advantages in fracture-risk assessment and short-term monitoring. REMS also avoids ionizing radiation, which makes repeat monitoring easier to discuss with patients.
That matters because bone is dynamic. Bone changes with hormones, nutrition, resistance training, inflammation, medications, weight loss, and disease. A patient losing weight rapidly, entering menopause, taking steroids, starting hormone-blocking therapy, or recovering from an eating disorder may not need a bone conversation five years from now. They may need one now.
REMS is not perfect. DEXA is not perfect. No test is the patient. But if we wait until fracture to take bone seriously, we have waited too long.
The future of bone health should be earlier, safer, more accessible, and more clinically integrated. Testing should lead to action: protein, resistance training, vitamin D correction, fall prevention, hormone evaluation when appropriate, medication review, secondary-cause workup, and osteoporosis treatment when indicated.
The best fracture is the one that never happens. That requires finding risk before the fall.
Steven E. Warren is a triple board-certified physician with more than 45 years of clinical experience spanning frontier medicine, occupational health, and regenerative longevity. Over the course of his career, he has delivered hundreds of babies, performed surgeries in rural counties larger than Rhode Island, and served in roles ranging from county coroner to rodeo doctor.
Now practicing in the Salt Lake City area, Dr. Warren specializes in cellular optimization and longevity medicine at Regenerative Wellness Center and serves as medical director of Best 365 Labs. He is also associated with Get Happy MD.
Dr. Warren is the author of ten books, including The Living Chip, The Owner’s Living Chip Manual, How It All Works, Elephants in the Exam Room, The Rigged Game, No Bull Money, Shape Up or Ship Out, and No Bull Nursing Home. His published research includes a Cureus study examining a nonhormonal testosterone booster in 15 patients.
