About Bone Evaluation by CCOA

Why is it important to have your bones evaluated by REMS?

A broken bone can be a life changing event in any circumstance, but it is especially true if the fracture is due to the bone being frail or weak (fragility fracture). Many people who break their hip due to frailty never fully recover from that injury and often never return to their normal activities and function. Many lose their independence. Premature death is associated with fragility fractures. As we get older, bone frailty is the most common reason for fracturing. It is often associated with other serious medical conditions, muscle weakness,  and general poor health.  Bone health is a significant aspect of our general health and needs to be assessed and routinely monitored!

Bone assessment is preventative medicine – it is the core of fracture prevention. Early screening is essential. By 65, a woman may have lost 30% of bone mass significantly limiting treatment options. Early bone assessment establishes a baseline and then routine monitoring is recommended. This recommendation for bone health monitoring is in line with other recommended health care monitoring - blood pressure, cholesterol, and diabetes screening.

CCOA has been taking care of bones in the traditional orthopedic way for almost 2 decades - by fixing them after they have broken. About 5 years ago, CCOA began to transition from a traditional orthopedic surgery practice focused on fracture fixation to a bone assessment practice focused on fracture prevention. Our new goal became assessing your bone before it breaks and helping you understand how to use that information to keep from fracturing.

REMS bone assessment provides vital information about your skeleton. Otherwise, how can anyone know if bone breakdown is happening? Also, how can you know that your diet, the exercise you are doing, the supplements that you are taking, and other treatments recommended to you by your doctor are working?

DXA is the traditional method of assessing bone by indirectly measuring bone mineral density (BMD) using x-ray radiation. Although, the amount of radiation exposure per DXA scan is relatively small, the detrimental effects of radiation are cumulative and therefore add to a person’s lifetime radiation exposure. Also, exposure of younger individuals to radiation especially during child-bearing years is not recommended. Recently, the International Osteoporosis Foundation questioned the usefulness of BMD as a method of screening for bone frailty.

A REMS bone assessment is performed using ultrasound and is radiation-free. More importantly, REMS determines bone structure in addition to providing traditional BMD values.  The internal structure (microarchitecture) of a bone will determine the bone strength. It is the strength of a bone that determines if it will break – a weak bone breaks a strong bone is fracture resistant. REMS technology offers a method of assessing bone strength to determine fracture risk. 

We are excited to help providers, patients, and employers get access to this new technology and partner with them to prevent fragility fractures. 

Schedule your REMS scan today with Dr. Bush at his office in Pittsboro, NC or sign up for notifications of clinics he schedules outside of the area.

Our Mission

At Bone Evaluation by CCOA,

we believe strong bones are the foundation of an active and healthy life!

It is our mission to provide accessible, reliable, and affordable bone assessment for people of all ages!

From Dr. Bush:

Bone Evaluation at CCOA is the most experienced REMS practice in North America. We are proud of our reputation for not only providing quality bone assessment with REMS but providing detailed and evidence-based consultations. Our unique perspective on the importance of bone strength to determine fracture risk distinguishes us from traditional bone assessment protocols based on BMD. We emphasize the importance of maintaining a healthy skeleton by maintaining bone and muscle strength through exercise, proper nutrition, and a healthy lifestyle along with routine screening and monitoring of bone with the goal of preventing fragility fractures.

As a retired Board-Certified Orthopedic Surgeon and having practiced orthopedic surgery for almost 30 years I was in a unique position when we began our transition away from fracture fixation to fracture prevention. Being a member of the International Society of Clinical Densitometry, I trained to be proficient in DXA; however, I chose to use REMS technology over DXA.  Even though REMS was still a relatively new technology, it was obvious to me that I was going to use REMS as the foundation for my bone assessment practice.   My hands-on experience working with bone for decades, gave me a practical perspective that a bone's structure determines its strength.  And, it is the bone's strength that determines if a bone is going to break - weak bone breaks and strong bone is fracture resistant! That just makes sense!

Reading through the content of this website, you probably have noticed that the vocabulary we are using is not what you might have come to expect when you speak to your health care provider about your bone health. Bone strength is repeatedly emphasized as we discuss fracture risk and words like "osteoporosis" and "osteopenia" are mentioned only to contrast the new vs. old way of thinking about bone health.  Muscle strength is stressed based on the simple concept: if you have no  muscle, you will have no bone! Echolight is developing software that will enable REMS to measure muscle mass. With that inovation, a REMS evaluation will provide significantly new and important information about your bone health.

REMS provides an accurate, accessible, and affordable way of assessing bone strength and therefore fracture risk. It is imperative that information about REMS needs to be universally promoted so that all can benefit from this revolutionary technology. I see my role not only as a REMS provider, but as a an educator with the duty to inform the bone health community about the importance of maintaining bone strength and the role that REMS can play in monitoring bone strength to decrease fracture risk and prevent fragility fractures.

And please remember -

- ignore your bones (and muscles) and they will go away!

Our Values

Affiliates / Associates

The Future

As Bone Evaluation at CCOA enters the next decade, we remain committed to the goal, helping people of all ages build strong bones for life. We'll never stop innovating new technologies and educational tools to empower our community.

Our bones support us through life's adventures.

Let us support your bones and remember….

Ignore your bones and they will go away!

From Dr. Bush:

I am a Board-Certified Orthopedic Surgeon, practicing for almost 30 years. I trained at the University of Medicine and Dentistry - NJMS, University Hospital in Newark, NJ. I have been providing orthopedic surgery care in Sanford, North Carolina for the past 17 years as an independent private practitioner. Recently, I shifted the scope of my orthopedic practice from fracture fixation to fracture prevention. I am a member of the International Society of Clinical Densitometry and I have trained to be proficient in DXA interpretation; however, what sets my Bone Health practice apart from other practices is my embracing of REMS (Radiofrequency Echographic Multi Spectrometry) technology for densitometry and fracture risk determination.

Currently, my practice is the largest clinical REMS practice in North America. My Bone Health program is growing due to the level of care that we provide – the thorough assessment of bone health and emphasizing the importance of maintaining a healthy skeleton by maintaining bone strength through a healthy lifestyle, exercise and proper nutrition along with routine screening and monitoring of bone health with the goal of preventing fragility fractures.