```

[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3856 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3856

To amend the Public Health Service Act to provide for osteoporosis and 
  related bone disease education, research, and surveillance, and for 
                            other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            October 20, 2009

 Ms. Berkley (for herself, Mr. Burgess, Mrs. Davis of California, Mr. 
 Higgins, Ms. Lee of California, Ms. Kilpatrick of Michigan, Ms. Eddie 
 Bernice Johnson of Texas, Ms. Corrine Brown of Florida, Mr. Klein of 
Florida, Ms. Loretta Sanchez of California, Ms. Titus, Ms. Tsongas, Ms. 
DeGette, Mr. Lewis of Georgia, Ms. Woolsey, Ms. Moore of Wisconsin, Ms. 
  Schakowsky, Mr. Donnelly of Indiana, Ms. Schwartz, Mr. Doggett, Ms. 
   Matsui, Ms. Hirono, Mrs. Napolitano, Mr. Farr, Mr. Pascrell, Mr. 
 Capuano, Mr. Gene Green of Texas, Ms. Watson, Mr. Kennedy, Mr. Hare, 
 Mr. Cleaver, Mrs. Halvorson, Ms. Pingree of Maine, Ms. Jackson-Lee of 
 Texas, Mr. Sires, Mr. Ortiz, Mr. Davis of Illinois, Mr. Nadler of New 
York, Mr. Matheson, Ms. Baldwin, Mr. Kagen, Ms. Wasserman Schultz, Ms. 
   Harman, Ms. Eshoo, Mr. McDermott, Mr. Thompson of California, Mr. 
 Cohen, Ms. Shea-Porter, Mr. Engel, Mr. Wexler, Ms. Castor of Florida, 
Mrs. Christensen, Ms. Richardson, Mr. Crowley, Mr. Weiner, Mr. Yarmuth, 
Ms. Markey of Colorado, Mrs. Maloney, Ms. Fudge, Mr. Payne, Mrs. Lowey, 
   Ms. Zoe Lofgren of California, and Mr. Bilirakis) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL

 
To amend the Public Health Service Act to provide for osteoporosis and 
  related bone disease education, research, and surveillance, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Bone Health Promotion and Research 
Act of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Bone health is critical to the overall health and 
        quality of life of Americans. Bone provides mobility, support, 
        and protection for the body and acts as a storehouse for 
        essential minerals.
            (2) Osteoporosis is a condition in which the bones become 
        weak and can break from a minor fall or, in serious cases, from 
        simple actions such as sneezing. An estimated 34,000,000 
        Americans have low bone mass or osteopenia, which puts them at 
        risk for osteoporosis and bone fractures. In addition, 
        10,000,000 Americans have osteoporosis.
            (3) Eight million of those with osteoporosis are women, and 
        an estimated 2,000,000 American men have osteoporosis. The 
        United States Surgeon General says that by 2020 one in two 
        Americans over age 50 is expected to have or to be at risk of 
        developing osteoporosis of the hip; even more will be at risk 
        of developing osteoporosis at any site in the skeleton.
            (4) According to estimated figures, osteoporosis was 
        responsible for more than 2,000,000 fractures in 2005, 
        including hip, spine, wrist, and other fractures. The number of 
        fractures due to osteoporosis is expected to rise to more than 
        3,000,000 by 2025. Approximately 1 in 2 women and up to 1 in 4 
        men over age 50 will break a bone because of osteoporosis.
            (5) An average of 24 percent of hip fracture patients age 
        50 and older die in the year following their fracture.
            (6) Osteoporosis costs our health care system an estimated 
        $19,000,000,000 each year. By 2025, experts predict that 
        osteoporosis will account for $25,300,000,000 in costs.
            (7) Individuals with certain diseases are at higher risk of 
        developing osteoporosis. For example, diabetes patients are at 
        increased risk for developing an osteoporosis-related fracture. 
        Cancer patients are also at increased risk because many cancer 
        therapies, such as chemotherapy and corticosteroids, have 
        direct negative effects on bone. Also, certain cancers, 
        including prostate and breast cancer, may be treated with 
        hormonal therapy, which can cause bone loss.
            (8) Osteogenesis imperfecta is characterized by fragile 
        bones and frequent fractures. It is estimated to afflict an 
        estimated 40,000 people.
            (9) Paget's disease of the bone, a geriatric disorder that 
        results in enlarged and deformed bones in one or more parts of 
        the body, afflicts an estimated 700,000 Americans over the age 
        of 60.
            (10) Lifestyle factors can affect bone health. For example, 
        the chemicals in cigarette smoke are harmful to bone cells and 
        smoking may make it harder to absorb calcium. Heavy drinking 
        can reduce bone formation and may also affect the body's 
        calcium supply.
            (11) The 2004 Surgeon General's Report, ``Bone Health and 
        Osteoporosis: A Report of the Surgeon General,'' said that 
        Americans must be encouraged to: get enough calcium and vitamin 
        D; engage in regular weight-bearing and muscle-strengthening 
        exercise; avoid smoking and excessive alcohol; and talk to 
        their healthcare providers about bone health.
            (12) Greater efforts and commitments are needed from 
        Congress, the States, providers, and patients to lessen the 
        burden of osteoporosis and related bone diseases on Americans.

SEC. 3. NATIONAL BONE HEALTH PROGRAM.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 314 the following:

``SEC. 315. NATIONAL BONE HEALTH PROGRAM.

    ``(a) Establishment of Program.--The Secretary may develop and 
implement a National Bone Health Program (in this section referred to 
as the `Program') consistent with this section.
    ``(b) Control, Prevention, and Surveillance.--
            ``(1) In general.--Under the Program, the Secretary, acting 
        through the Director of the Centers for Disease Control and 
        Prevention, may, directly or through competitive grants to 
        eligible entities, conduct, support, and promote the 
        coordination of research, investigations, demonstrations, 
        training, and studies relating to the control, prevention, and 
        surveillance of osteoporosis and related bone diseases.
            ``(2) Training and technical assistance.--With respect to 
        the planning, development, and operation of any activity 
        carried out under paragraph (1), the Secretary may provide 
        training, technical assistance, supplies, equipment, or 
        services, and may assign any officer or employee of the 
        Department of Health and Human Services to a State or local 
        health agency, or to any public or nonprofit entity designated 
        by a State health agency, in lieu of providing grant funds 
        under this subsection.
            ``(3) Osteoporosis and related bone disease prevention 
        research at the centers for disease control and prevention.--
        The Secretary may provide additional grant support under this 
        subsection to encourage the expansion of research related to 
        the prevention and management of osteoporosis and related bone 
        diseases at the Centers for Disease Control and Prevention.
            ``(4) Eligible entity.--For purposes of this subsection, 
        the term `eligible entity' means a national public or private 
        nonprofit entity that demonstrates to the satisfaction of the 
        Secretary, in the application described in subsection (e), the 
        ability of the entity to carry out the activities described in 
        paragraph (1).
    ``(c) Education and Outreach.--
            ``(1) In general.--Under the Program, the Secretary may 
        coordinate and carry out national education and outreach 
        activities, directly or through the provision of grants to 
        eligible entities, to support, develop, and implement education 
        initiatives and outreach strategies appropriate for 
        osteoporosis and related bone diseases.
            ``(2) Initiatives and strategies.--Initiatives and 
        strategies implemented under paragraph (1) may include public 
        awareness campaigns, public service announcements, and 
        community partnership workshops, as well as programs targeted 
        at businesses and employers, managed care organizations, and 
        health care providers.
            ``(3) Priority.--In carrying out paragraph (1), the 
        Secretary--
                    ``(A) may emphasize prevention, early diagnosis, 
                and appropriate management of osteoporosis and related 
                bone disease, and opportunities for effective patient 
                self-management; and
                    ``(B) may give priority to reaching high-risk or 
                underserved populations.
            ``(4) Collaboration.--In carrying out this subsection, the 
        Secretary shall consult and collaborate with the Advisory 
        Committee established in subsection (g).
            ``(5) Eligible entity.--For purposes of this subsection, 
        the term `eligible entity' means a national public or private 
        nonprofit entity that demonstrates to the satisfaction of the 
        Secretary, in the application described in subsection (e), the 
        ability of the entity to carry out the activities described in 
        paragraph (1).
    ``(d) Comprehensive State Grants.--
            ``(1) In general.--Under the Program, the Secretary may 
        award grants to eligible entities to provide support for 
        comprehensive osteoporosis and related bone disease control and 
        prevention programs and to enable such entities to provide 
        public health surveillance, prevention, and control activities 
        related to osteoporosis and related bone diseases.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection, an entity shall be a State or Indian tribe.
            ``(3) Application.--To be eligible to receive a grant under 
        this subsection, an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        agreements, assurances, and information as the Secretary may 
        require, including a comprehensive osteoporosis and related 
        bone disease control and prevention plan that--
                    ``(A) is developed with the advice of stakeholders 
                from the public, private, and nonprofit sectors that 
                have expertise relating to osteoporosis and related 
                bone disease control, prevention, and treatment that 
                increase the quality of life and decrease the level of 
                disability;
                    ``(B) is intended to reduce the morbidity of 
                osteoporosis and related bone diseases, with priority 
                on preventing and controlling osteoporosis and related 
                bone diseases in at-risk populations and reducing 
                disparities in osteoporosis and related bone disease 
                prevention, diagnosis, management, and quality of care 
                in underserved populations;
                    ``(C) describes the osteoporosis and related bone 
                disease services and activities to be undertaken or 
                supported by the entity; and
                    ``(D) demonstrates the relationship the entity has 
                with the community and local entities and how the 
                entity plans to involve such community and local 
                entities in carrying out the activities described in 
                paragraph (1).
            ``(4) Use of funds.--An eligible entity may use amounts 
        received under a grant awarded under this subsection to 
        conduct, in a manner consistent with the comprehensive 
        osteoporosis and related bone disease control and prevention 
        plan submitted by the entity in the application under paragraph 
        (3)--
                    ``(A) public health surveillance and 
                epidemiological activities relating to the prevalence 
                of osteoporosis and related bone disease and assessment 
                of disparities in osteoporosis and related bone disease 
                prevention, diagnosis, management, and care;
                    ``(B) public information and education programs; 
                and
                    ``(C) education, training, and clinical skills 
                improvement activities for health professionals, 
                including allied health personnel.
    ``(e) General Application.--To be eligible to receive a grant under 
this section, except under subsection (d), an entity shall submit to 
the Secretary an application at such time, in such manner, and 
containing such agreements, assurances, and information as the 
Secretary may require, including a description of how funds received 
under a grant awarded under this section will supplement or fulfill 
unmet needs identified in a comprehensive osteoporosis and related bone 
disease control and prevention plan of the entity.
    ``(f) Definitions.--For purposes of this section:
            ``(1) Indian tribe.--The term `Indian tribe' has the 
        meaning given such term in section 4(e) of the Indian Self-
        Determination and Education Assistance Act.
            ``(2) State.--The term `State' means any State of the 
        United States, the District of Columbia, the Commonwealth of 
        Puerto Rico, the Virgin Islands, American Samoa, Guam, and the 
        Northern Mariana Islands.
    ``(g) Advisory Committee.--
            ``(1) Establishment.--Not later than 90 days after the date 
        of the enactment of this section, the Secretary, acting through 
        the Director of the Centers for Disease Control and Prevention, 
        shall establish a committee to be known as the Osteoporosis and 
        Related Bone Disease Advisory Committee (referred to in this 
        section as the `Advisory Committee'). The Advisory Committee 
        shall be composed of at least one member, to be appointed by 
        the Secretary, acting through the Director of the Centers for 
        Disease Control and Prevention, representing each of the 
        following:
                    ``(A) National voluntary health organizations that 
                focus on issues relating to osteoporosis or other bone 
                diseases.
                    ``(B) Professional societies that focus on issues 
                relating to osteoporosis or other bone diseases.
                    ``(C) The Centers for Disease Control and 
                Prevention, to include, upon the recommendation of the 
                Director of the Centers, representatives of the 
                Coordinating Center for Health Promotion, the 
                Coordinating Center for Health Information and Service, 
                and the Coordinating Center for Environmental Health 
                and Injury Prevention.
                    ``(D) State public health departments.
                    ``(E) The National Institutes of Health, to 
                include, upon the recommendation of the Director of the 
                National Institutes of Health, representatives of the 
                National Institute of Arthritis and Musculoskeletal and 
                Skin Diseases, the National Cancer Institute, the 
                National Institute of Biomedical Imaging and 
                Bioengineering, the National Institute of Child Health 
                and Human Development, the National Institute of Dental 
                and Craniofacial Research, the National Institute of 
                Diabetes and Digestive and Kidney Diseases, the 
                National Institute on Aging, the Office of Dietary 
                Supplements, the Office of Rare Diseases, and the 
                Office of Research on Women's Health.
                    ``(F) Patients with osteoporosis or related bone 
                diseases or their family members.
                    ``(G) The Office on Women's Health in the 
                Department of Health and Human Services.
                    ``(H) Clinicians with expertise on osteoporosis or 
                related bone diseases.
                    ``(I) Other stakeholders from the public, private, 
                and nonprofit sectors with expertise relating to 
                osteoporosis or other bone disease control, prevention, 
                and treatment.
            ``(2) Duties.--The Advisory Committee shall advise the 
        Secretary and the Assistant Secretary for Health regarding the 
        manner in which such officials can--
                    ``(A) ensure interagency coordination and 
                communication and minimize overlap regarding efforts to 
                address osteoporosis and related bone diseases;
                    ``(B) conduct and support national education and 
                outreach activities;
                    ``(C) identify opportunities to coordinate efforts 
                with other Federal and State agencies and private 
                organizations addressing such diseases;
                    ``(D) ensure that public health policy decisions 
                and information disseminated to the public and 
                physicians are evidence-based and population-focused;
                    ``(E) advise relevant Federal agencies on 
                priorities related to osteoporosis and related bone 
                diseases;
                    ``(F) conduct surveillance and data collection and 
                disseminate epidemiological information in accordance 
                with section 32OB; and
                    ``(G) expand and intensify research on osteoporosis 
                and related bone diseases in accordance with section 
                404I.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            ``(1) for fiscal year 2010, $22,000,000;
            ``(2) for fiscal year 2011, $24,000,000;
            ``(3) for fiscal year 2012, $26,000,000;
            ``(4) for fiscal year 2013, $28,000,000; and
            ``(5) for fiscal year 2014, $30,000,000.''.

SEC. 4. HHS RESEARCH ACTIVITIES WITH RESPECT TO OSTEOPOROSIS AND 
              RELATED BONE DISEASES.

    Part A of title IV of the Public Health Service Act (42 U.S.C. 281 
et seq.) is amended by adding at the end the following:

``SEC. 404I. BONE HEALTH INITIATIVE.

    ``(a) Expansion and Intensification of Activities.--
            ``(1) In general.--The Director of NIH shall expand and 
        intensify programs of the National Institutes of Health with 
        respect to research and related activities concerning 
        osteoporosis and related bone diseases, including osteogenesis 
        imperfecta, Paget's disease of bone, and rare bone diseases.
            ``(2) Coordination; consultation.--The Director of NIH 
        shall carry out paragraph (1)--
                    ``(A) in coordination with the directors of the 
                National Institute of Arthritis and Musculoskeletal and 
                Skin Diseases, the National Cancer Institute, the 
                National Institute of Biomedical Imaging and 
                Bioengineering, the National Institute of Child Health 
                and Human Development, the National Institute of Dental 
                and Craniofacial Research, the National Institute of 
                Diabetes and Digestive and Kidney Diseases, the 
                National Institute on Aging, the Office of Rare 
                Diseases, the Office of Research on Women's Health, and 
                any other national research institutes or offices, as 
                appropriate; and
                    ``(B) in consultation with additional Federal 
                officials, the advisory committee established under 
                section 315(g), and any national voluntary health 
                organizations, professional societies, and private 
                entities, as appropriate.
    ``(b) Planning Grants and Contracts for Innovative Research in 
Osteoporosis and Related Bone Diseases.--
            ``(1) In general.--In carrying out subsection (a)(1), the 
        Director of NIH shall award planning grants or contracts for 
        the establishment of new research programs, or enhancement of 
        existing research programs, that focus on osteoporosis and 
        related bone diseases, including osteogenesis imperfecta, 
        Paget's disease of bone, and rare bone diseases.
            ``(2) Research.--
                    ``(A) Types of research.--In carrying out this 
                subsection, the Secretary shall encourage basic, 
                clinical, and translational research that focuses on 
                osteoporosis and related bone diseases, including 
                osteogenesis imperfecta, Paget's disease of bone, and 
                rare bone diseases.
                    ``(B) Priority.--In awarding planning grants or 
                contracts under paragraph (1), the Director of NIH may 
                give priority to collaborative partnerships, which may 
                include academic health centers, private sector 
                entities, and nonprofit organizations.
                    ``(C) New and early stage investigators.--The 
                Director of NIH shall make an effort to fund research 
                by new and early stage investigators under paragraph 
                (1).
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $300,000,000 
for each of fiscal years 2010 through 2014. Such authorization shall be 
in addition to any authorization of appropriations under any other 
provision of law to carry out research activities on osteoporosis or 
related bone diseases.''.

SEC. 5. SURVEILLANCE ACTIVITIES RELATED TO BONE DISEASES AT THE CENTERS 
              FOR DISEASE CONTROL AND PREVENTION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 320A the following:

``SEC. 320B. SURVEILLANCE REGARDING OSTEOPOROSIS AND RELATED BONE 
              DISEASES.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, may award grants to and 
enter into cooperative agreements with public or nonprofit private 
entities for the collection, analysis, and reporting of data on 
osteoporosis and related bone diseases, including osteogenesis 
imperfecta and Paget's disease of bone.
    ``(b) Technical Assistance.--In awarding grants and entering into 
agreements under subsection (a), the Secretary may provide direct 
technical assistance in lieu of cash.
    ``(c) Coordination With Advisory Committee and NIH.--The Secretary 
shall ensure that epidemiological and other types of information 
obtained under subsection (a) is made available to the National 
Institutes of Health. The advisory committee established under section 
315(g) shall advise the Secretary in the coordination of 
epidemiological efforts and in the expansion and intensification of 
programs for conducting surveillance and data collection activities 
under this section.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $25,000,000 
for each of fiscal years 2010 through 2014.''.
                                 <all>
```