This collection of studies brings together a robust and growing body of clinical evidence examining bone mineral density assessment, osteoporosis diagnosis, and fracture risk prediction using Radiofrequency Echographic Multi-Spectrometry (REMS) technology. Across diverse populations and clinical contexts, the research consistently evaluates REMS as a non-ionising, ultrasound-based alternative to dual-energy X-ray absorptiometry (DXA), the current reference standard for bone density measurement.

Collectively, the studies demonstrate that REMS provides bone mineral density measurements at key skeletal sites, particularly the lumbar spine and proximal femur, that show strong agreement and high correlation with DXA-derived values. Importantly, REMS maintains high diagnostic accuracy, sensitivity, specificity, and precision when identifying osteoporosis and osteopenia, including in populations traditionally challenging for DXA assessment, such as individuals with osteoarthritis, obesity, scoliosis, spinal degeneration, or implanted hardware.

Several investigations highlight REMS’ ability to overcome known DXA limitations, particularly the overestimation of lumbar spine bone mineral density caused by degenerative changes, osteophytes, and calcifications. By analysing raw, unfiltered ultrasound radiofrequency signals and automatically excluding structural artefacts, REMS offers a more reliable assessment of true bone status in these settings. This capability is shown to improve osteoporosis detection rates and support earlier clinical intervention.

Beyond cross-sectional diagnostic performance, longitudinal and predictive studies within this collection demonstrate that REMS-derived parameters, including the Fragility Score, are effective in estimating future fracture risk over extended follow-up periods. In several analyses, REMS-based risk indicators perform as well as or better than DXA T-scores in predicting incident fragility fractures, reinforcing the technology’s value not only for diagnosis but also for long-term risk stratification.

The research further supports the clinical applicability of REMS across a wide range of patient groups, including men, postmenopausal women, individuals with chronic kidney disease, pregnant women, and patients with severe motor or intellectual disabilities. The absence of ionising radiation enables repeated assessments and use in populations where DXA is unsuitable or impractical, expanding access to safe Bone Health Assessment.

Overall, the studies presented in this volume establish REMS as a validated, precise, and clinically meaningful technology for bone health assessment. Taken together, they position REMS as a complementary and, in specific contexts, advantageous alternative to DXA for osteoporosis diagnosis, monitoring, and fracture risk prediction within modern clinical practice.