Meeting Reports 2005

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center
Bone Health and Osteoporosis: Next Steps

National Institutes of Health (NIH)
U.S. Department of Health and Human Services (DHHS)

Meeting Summary

PDF Version

The Mark O. Hatfield Clinical Research Center
Medical Board Room
November 3, 2005

Welcome and Introductions

Members of the National Coordinating Panel of the National Institutes of Health Osteoporosis and Related Bone Diseases ~ National Resource Center met at the NIH Clinical Center on November 3, 2005, to discuss progress and next steps surrounding the release of the U.S. Surgeon General's Report on Bone Health and Osteoporosis. Joan McGowan, Ph.D., Director of the Musculoskeletal Diseases Branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), welcomed the participants.

Program Discussion

Stephen I. Katz, M.D., Ph.D., Director of the NIAMS, also welcomed the participants and thanked them for their efforts to publicize the report. He noted that the partnership of bone health organizations and the NIH has worked well. He asked the meeting participants to consider further steps for disseminating the report's messages.

Dr. Katz remarked on the ongoing need to encourage physicians to address potential osteoporosis in patients more often. As an example, he described an initiative reported on at a recent U.S. Bone and Joint Decade meeting (October 19, 2005, at NIAMS) by the American Association of Medical Colleges to achieve dedicated instruction in musculoskeletal medicine in 100 percent of medical schools.

Recent Activities and Initiatives: National Osteoporosis Foundation

Ethel Siris, M.D., President of the National Osteoporosis Foundation, highlighted the following three conclusions from the Surgeon General's Report:

  • In the United States, bone health is in jeopardy.
  • We have the knowledge to improve bone health.
  • There is a gap between what we must do and what we are currently doing to address bone health.

Physicians, after setting fractured bones, often do not follow up with any discussion of bone health and referrals for bone mineral density testing, osteoporosis assessment, and treatment if needed. The scientific community has been providing evidence-based knowledge about bone health, such as the need for exercise among our youth, yet Americans are not pursuing physical activity and better nutrition for their bone health sufficiently. A greater sense of urgency is needed. The NOF has been working on many fronts in this area, publishing editorials, developing an action plan, and sponsoring workshops.

Dr. Siris said the NOF envisions a future in which the medical community makes good bone health a standard of care. She encouraged the Federal Government to disseminate a synopsis of the Surgeon General's Report or the consumer publication "What It Means To You" as a supplement in a variety of medical journals.

Dr. Katz stated that all medical specialties could be involved in bone health issues - noting, for example, the general prescribing of corticosteroids for many different conditions - and that influencing them all would be a large challenge. Dr. Siris remarked that primary care physicians are not emphasizing osteoporosis in the elderly. Judith Cranford, Executive Director of the National Osteoporosis Foundation, noted that the Foundation established and works with an Interspecialty Medical Council comprised of 18 professional groups all sharing a common interest in bone health and osteoporosis.

Evidence into Action: Group Discussion

The Health Plan Employer Data and Information Set (HEDIS) is a standardized survey that features questions about a wide variety of health issues and, in its application, focuses attention on those issues. The meeting participants considered whether bone-health issues should be made a larger part of the HEDIS survey, which currently includes two questions about bone health. In a recent HEDIS survey, only about 18 percent of female patients reported bone-health followup after treatment for fractures.

The meeting participants cited some ongoing efforts to encourage bone-health advocacy among, for example, orthopedic surgeons. Dr. Siris noted that the World Health Organization will be releasing a technical document featuring an algorithm for the risk of fracture. The NOF plans to study the risk of fracture to determine how much risk is too much, based on cost-effectiveness.

Charlene Waldman, Executive Director of the Paget Foundation, stated that the Foundation is pleased with the Surgeon General's Report and is developing a print document based on the report's contents that relate to Paget's Disease. The Paget Foundation also supports the efforts of the American Association of Medical Colleges to incorporate musculoskeletal health education into medical school curricula.

Lisa Begg, Ph.D., of the NIH Office of Research on Women's Health (ORWH), emphasized the difficulty of placing new items in medical school curricula. The ORWH has approached medical boards, urging them to include bone-health material in board tests. The meeting participants discussed the possibility of approaching licensing boards, urging them to include material on bone health.

The participants considered whether bone health would be promoted more successfully if it were associated with a vital sign. Ideas for vital signs for bone health include pain, menses, and fracture. Fracture can be considered a sentinel event. Ms. Waldman suggested inviting representatives of the Pain Foundation to this group's future meetings. Keith McCormick, D.C., a guest of the NOF, identified himself as an osteoporosis patient and confirmed that pain is a significant aspect of the disease. Janet Hubert, another guest of the NOF who identified herself as a patient, added that osteoporosis patients tend not to discuss their condition. She urged the group to include a focus on minority groups when conducting public education programs.

Needs Assessment Overview: Group Discussion

Janet Austin, Ph.D., Director of the NIAMS Office of Communications and Public Liaison, reported that the NIH National Resource Center is currently conducting a needs assessment among organizations that represent various racial and ethnic populations to identify culturally appropriate communication strategies for disseminating the SGR messages and materials to these audiences. The organizations have provided insights into specific messages, print and electronic media options, communications devices, and distribution channels that would be of interest to minority groups.

Dr. McGowan recommended against emphasizing the threat of bone disease, which may be seen as unrealistic by many audiences. A better strategy might be to cite "red flags" that indicate potential bone health problems and to target the messages appropriately for different audiences. Bone health messages may also be better received if they are part of broader health messages.

Dr. Katz cautioned that potential behavioral change can be hard to evaluate in short time periods. Saralyn Mark, M.D., of the DHHS Office on Women's Health, noted that the Office has been working on a pubic education campaign that features astronauts, based on the connection between weightlessness and bone health.

Other suggestions for extending the SGR messages and materials included incorporating bone health into ongoing health campaigns by the Federal Government and voluntary health organizations and forming partnerships to create education campaigns that target aging citizens. NOF's Senior Director of Public Policy and Government Relations, Roberta Biegel, volunteered to report at a future meeting on progress in the NOF's community efforts.


Dr. Katz thanked the participants for their input and adjourned the meeting.