Knapp, KarenFulford, JonathanStrain, DavidAsiri, Mohammed2025-01-222024https://hdl.handle.net/20.500.14154/74715Rationale: The rising global prevalence of osteoporosis and its significant financial and healthcare costs have prompted a revaluation of existing diagnostic procedures, mostly focused on dual-energy X-ray absorptiometry. Despite its popularity and usefulness, DXA has downsides that include radiation exposure, high prices, restricted availability in developing countries, and erroneous findings impacted by body fat composition. These limitations have led to the development of alternative diagnostics. Radiofrequency echographic multi-spectrometry (REMS) is a new method that uses ultrasound and advanced algorithms to evaluate bone health. However, its broad use and validation in varied therapeutic situations remain obstacles. Method: ​The precision error rate was measured to assess the ability of REMS to provide precise measurements. Seven operators scanned 61 participants' femur and lumbar spines to measure inter- and intra-operator reproducibility. Short-term precision tests were performed on 15 subjects, 10 continuing for medium- and long-term evaluations. Another 168 men and women were recruited to have REMS and DXA scans of the lumbar spine and femur. This set-up tested REMS' reliability and capacity to distinguish fracture patients. The study also compared REMS readings with DXA results in diabetes as a disease affecting bone density. A subset of 23 participants was scanned for abdominal fat thickness measurement to explore the influence of fat on REMS measurements. Finally, a survey assessed the acceptability of participants with REMS technology and examined how body composition affects measurement accuracy. Results: REMS had a better precision error rate than DXA in evaluating bone density in the lumbar spine and femur. REMS performed better in femoral evaluations than in the spine, in reasonable agreement with DXA and may detect osteoporosis and discriminate bone health states. Fracture risk prediction was more sensitive with DXA. The survey showed a negligible effect of body composition on the REMS measures and favourable participant approval. Despite these promising results, the study stressed the necessity to validate REMS in under-represented populations and diverse clinical settings. Conclusion: This Ph.D. project showed the promise of REMS as a novel osteoporosis diagnostic tool, highlighting its strengths and weaknesses. Based on the findings, REMS technology could potentially serve as a primary or supportive tool in the diagnosis and management of osteoporosis. Further research is essential to refine its diagnostic accuracy and efficacy in different demographics and clinical contexts. Expanding the evidence base will solidify the role of REMS in osteoporosis care.284enOsteoporosisultrasoundQuantitative ultrasoundRadiofrequency Echographic multi-spectrometryREMSEcholightThesis