I
103D CONGRESS
1ST SESSION
H. R. 1844
To amend the Public Health Service Act to expand and intensify programs
of the National Institutes of Health with respect to research and related
activities concerning osteoporosis and related bone disorders.
IN THE HOUSE OF REPRESENTATIVES
APRIL 22, 1993
Ms. SNOWE introduced the following bill; which was referred to the Committee
on Energy and Commerce
A BILL
To amend the Public Health Service Act to expand and
intensify programs of the National Institutes of Health
with respect to research and related activities concerning
osteoporosis and related bone disorders.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Osteoporosis and Re-
lated Bone Disorders Research, Education, and Health
Services Act of 1993’’.
SEC. 2. FINDINGS.
The Congress finds that—
(1) osteoporosis, or porous bone, is a condition
characterized by an excessive loss of bone tissue and
an increased susceptibility to fractures of the hip,
spine, and wrist;
(2) an estimated 25,000,000 Americans have
osteoporosis, with many cases undiagnosed because
the condition develops without symptoms until a
strain, bump, or fall causes a fracture;
(3) between 3 and 4 million Americans have
Paget’s disease, Osteogenesis Imperfecta, and other
related metabolic bone disorders;
(4) osteoporosis is responsible for 1,300,000
bone fractures annually, including more than
250,000 hip fractures, 500,000 vertebral fractures,
200,000 fractures of the wrist, and the remaining
fractures at other limb sites;
(5) osteoporosis affects one-third to one-half of
all postmenopausal women and nearly half of all
people over age 75;
(6) direct medical costs of osteoporosis reached
an estimated $10,000,000,000 in 1988 for the Unit-
ed States, not including the costs of family care and
lost work for caregivers;
(7) direct medical costs of osteoporosis are ex-
pected to increase precipitously because the propor-
tion of the population comprised of older persons is
expanding and each generation of older persons
tends to have a higher incidence of osteoporosis than
preceding generations;
(8) technology now exists, and new technology
is developing, that will permit early diagnosis and
prevention of osteoporosis as well as management of
the condition once it has developed;
(9) funding for research on osteoporosis and re-
lated bone disorders is severely constrained at key
research institutes, including the National Institute
of Arthritis and Musculoskeletal and Skin Diseases,
the National Institute on Aging, and the National
Institute of Diabetes and Digestive and Kidney Dis-
eases;
(10) further research is needed to improve med-
ical knowledge concerning—
(A) cellular mechanisms related to the
processes of bone resorption and bone forma-
tion, and the effect of different agents on bone
remodeling;
(B) risk factors for osteoporosis, including
newly discovered risk factors, risk factors relat-
ed to groups not ordinarily studied, such as
men and minorities, and the relationship of
aging 
processes 
to 
the 
development 
of
osteoporosis;
(C) bone mass measurement technology,
including techniques for making faster and
more precise measurements and for interpreting
measurements;
(D) calcium, including bioavailability, in-
take requirements, and the role of calcium in
building heavier and denser skeletons;
(E) prevention and treatment, including
the efficacy of current therapies, alternative
drug therapies for prevention and treatment,
and the role of exercise; and
(F) rehabilitation; and
(11) further educational efforts are needed to
increase public and professional knowledge of the
causes of, methods for avoiding, and treatment of
osteoporosis.
SEC. 3. OSTEOPOROSIS RESEARCH.
Subpart 4 of part C of title IV of the Public Health
Service Act (42 U.S.C. 285d et seq.) is amended—
(1) by inserting after the subpart designation
and heading the following:
‘‘DIVISION A—ARTHRITIS’’;
and
(2) by adding at the end the following:
‘‘DIVISION B—OSTEOPOROSIS
‘‘SEC. 442A. DEFINITIONS.
‘‘As used in this division:
‘‘(1) ADVISORY
PANEL.—The term ‘Advisory
Panel’ means the Advisory Panel on Osteoporosis
and Related Disorders, established in section 442D.
‘‘(2) COUNCIL.—The term ‘Council’ means the
Interagency Council on Osteoporosis and Related
Disorders, established in section 442C.
‘‘(3) DEPARTMENT.—The term ‘Department’
means the Department of Health and Human Serv-
ices.
‘‘(4) RELATED DISORDERS.—The term ‘related
bone disorders’ includes—
‘‘(A) Paget’s disease, a bone disease char-
acterized by enlargement and loss of density
with bowing and deformity of the bones;
‘‘(B) Osteogenesis Imperfecta, a familial
disease marked by extreme brittleness of the
long bones;
‘‘(C) hyperparathyroidism, a condition
characterized by the presence of excess para-
thormone in the body resulting in disturbance
of calcium metabolism with loss of calcium from
bone and renal damage;
‘‘(D) 
hypoparathyroidism, 
a 
condition
characterized by the absence of parathormone
resulting in disturbances of calcium metabolism;
‘‘(E) renal bone disease, a disease charac-
terized by metabolic disturbances from dialysis,
renal transplants, or other renal disturbances;
‘‘(F) 
primary 
or 
postmenopausal
osteoporosis and secondary osteoporosis, such
as that induced by corticosteroids; and
‘‘(G) other general disorders of bone and
mineral metabolism including abnormalities of
vitamin D.
‘‘(5) RESOURCE CENTER.—The term ‘Resource
Center’ means the Resource Center on Osteoporosis
and Related Disorders, established in section 442E.
‘‘SEC. 442B. EXPANSION OF RESEARCH ON OSTEOPOROSIS
AND RELATED BONE DISORDERS.
‘‘(a) RESEARCH.—The Director of the National Insti-
tute of Arthritis and Musculoskeletal and Skin Diseases,
the Director of the National Institute on Aging, and the
Director of the National Institute of Diabetes and Diges-
tive and Kidney Diseases shall expand and intensify re-
search on osteoporosis and related bone disorders. The re-
‘‘SEC. 442C. INTERAGENCY COUNCIL ON OSTEOPOROSIS
AND RELATED BONE DISORDERS.
‘‘(a) ESTABLISHMENT.—There is established in the
Department an Interagency Council on Osteoporosis and
Related Disorders. The Council shall be composed of—
‘‘(1) the Assistant Secretary for Health;
‘‘(2) the Surgeon General of the United States;
‘‘(3) the Assistant Secretary for Planning and
Evaluation of the Department;
‘‘(4) the Director of the National Institute of
Arthritis and Musculoskeletal and Skin Diseases;
‘‘(5) the Director of the National Institute on
Aging;
‘‘(6) the Director of the National Institute of
Diabetes, Digestive, and Kidney Diseases;
‘‘(7) the Director of the National Institute of
Mental Health;
‘‘(8) the Director of the National Institute of
Child Health and Human Development;
‘‘(9) the Administrator of the Health Care Fi-
nancing Administration;
‘‘(10) the Administrator for Health Care Policy
and Research;
‘‘(11) the Director of the Bureau of Child and
Maternal Health;
‘‘(12) the Commissioner of Food and Drugs;
‘‘(13) the Director of the National Institute of
Dental Research;
‘‘(14) the Commissioner on Aging;
‘‘(15) the Director of the Office of Disease Pre-
vention and Health Promotion; and
‘‘(16) such additional members as the Secretary
considers appropriate.
‘‘(b) FUNCTIONS.—The Council shall—
‘‘(1) coordinate research conducted by or
through the Department on osteoporosis and related
bone disorders;
‘‘(2) establish a mechanism for sharing infor-
mation on osteoporosis and related bone disorders
among all officers and employees of the Department
involved in carrying out programs serving older per-
sons, midlife women, and young persons, in order to
provide for full communication and exchange of in-
formation;
‘‘(3) review and coordinate the most promising
areas of research concerning osteoporosis and relat-
ed bone disorders;
‘‘(4) assist the National Institute of Arthritis
and Musculoskeletal and Skin Diseases, the National
Institute on Aging, the National Institute of Diabe-
tes, Digestive and Kidney Disease, the National In-
stitute on Dental Research, and other institutes in
developing and coordinating plans for research on
osteoporosis and related bone disorders;
‘‘(5) assist the Office of Disease Prevention and
Health Promotion and the Administration on Aging
and other offices in developing and coordinating
plans for education and health promotion on
osteoporosis and related bone disorders; and
‘‘(6) establish mechanisms to use the results of
research concerning osteoporosis and related bone
disorders in the development of policies, programs,
and other measures to improve the quality of life for
older Americans.
‘‘(c) CHAIRPERSON.—The Secretary shall select a
Chairperson or co-Chairpersons for the Council from
among its members.
‘‘(d) QUORUM.—A majority of the members of the
Council shall constitute a quorum, but a lesser number
may hold hearings.
‘‘(e) MEETINGS.—The Council shall meet periodically
at the call of the Chairperson, but not less often than twice
each year.
‘‘(f) EXECUTIVE SECRETARY.—The Secretary shall
appoint an Executive Secretary for the Council.
‘‘(g) ADMINISTRATIVE STAFF AND SUPPORT.—The
Secretary shall provide the Council with such additional
administrative staff and support as may be necessary to
enable the Council to carry out its functions.
‘‘(h) REPORTS.—
‘‘(1) INITIAL REPORT.—
‘‘(A) PREPARATION.—Not later than 9
months after the date of enactment of this divi-
sion, the Executive Secretary of the Council
shall prepare a report detailing the research
plans referred to in paragraphs (4) and (5) of
subsection (b). The report shall describe the ac-
tivities to be carried out under the research
plans during each of the fiscal years 1994
through 1996.
‘‘(B) OTHER
FEDERAL
PROGRAMS.—To
the maximum extent feasible, the report shall
ensure that activities carried out under the re-
search plans are coordinated with, and use the
resources of, other Federal programs concern-
ing osteoporosis and related bone disorders, in-
cluding—
‘‘(i) centers supported by the National
Institute of Arthritis and Musculoskeletal
and Skin Diseases, the National Institute
on Aging, and the National Institute of Di-
abetes, Digestive and Kidney Disease;
‘‘(ii) other centers supported by Fed-
eral 
funds 
involved 
in 
research 
on
osteoporosis and related bone disorders;
and
‘‘(iii) 
other 
programs 
concerning
osteoporosis and related bone disorders
that are planned or conducted by Federal
agencies such as the Administration on
Aging and the Office of Disease Prevention
and Health Promotion, Federal agencies
outside the Department, State or local
agencies, community organizations, or pri-
vate foundations.
‘‘(C) DISTRIBUTION.—The Executive Sec-
retary of the Council shall—
‘‘(i) transmit the report to Congress;
and
‘‘(ii) make the report available to the
public and to the Advisory Panel.
‘‘(2) SUBSEQUENT REPORTS.—Not later than
12 months after the date on which the report re-
quired by paragraph (1) is transmitted to Congress,
and annually thereafter, the Executive Secretary of
the Council shall—
‘‘(A) prepare a report that—
‘‘(i) describes research and edu-
cational initiatives sponsored by the Fed-
eral Government on osteoporosis and relat-
ed bone disorders; and
‘‘(ii) makes recommendations for new
research and educational initiatives on
osteoporosis and related bone disorders;
and
‘‘(B) transmit the report to Congress and
make the report available to the public.
‘‘SEC. 442D. ADVISORY PANEL ON OSTEOPOROSIS AND RE-
LATED DISORDERS.
‘‘(a) ESTABLISHMENT.—There is established in the
Department an Advisory Panel on Osteoporosis and Relat-
ed Disorders. The Advisory Panel shall be composed of
the following 15 voting members and additional nonvoting,
ex officio members:
‘‘(1) VOTING MEMBERS.—The Director of the
Office of Technology Assessment shall appoint to the
Advisory Panel—
‘‘(A) 5 members who are biomedical re-
search scientists with demonstrated achieve-
ment in biomedical research on osteoporosis and
related bone disorders, including at least 1 re-
searcher at a specialized center for research in
osteoporosis;
‘‘(B) 
members 
with 
demonstrated
achievements in research on community-based
and family services covering osteoporosis and
related bone disorders;
‘‘(C) 1 member who is knowledgeable in
health promotion and disease prevention pro-
grams concerning osteoporosis and related bone
disorders;
‘‘(D) 2 members who are associated with
specialized bone programs affiliated with aca-
demic health centers;
‘‘(E) 2 members who are experts in private
health care insurance and long-term care fi-
nancing; and
‘‘(F) 3 members who are representatives of
national voluntary organizations that are con-
cerned with the problems of individuals with
osteoporosis and related bone disorders and
their families.
‘‘(2) NONVOTING, EX OFFICIO MEMBERS.—The
Advisory Panel shall include as nonvoting, ex officio
members—
‘‘(A) the Chairperson of the Council;
‘‘(B) the Director of National Institute of
Arthritis and Musculoskeletal and Skin Dis-
eases;
‘‘(C) the Director of the National Institute
on Aging;
‘‘(D) the Director of the National Institute
of Diabetes and Digestive and Kidney Diseases;
and
‘‘(E) such other members as the Secretary
may appoint.
‘‘(3) APPOINTMENT.—The Director of the Of-
fice of Technology Assessment shall appoint mem-
bers to the Advisory Panel within 90 days after the
date of enactment of this division. The Director shall
not appoint to the Advisory Panel individuals who
are officers or employees of the Federal Government.
‘‘(b) FUNCTIONS.—The Advisory Panel shall advise
the Secretary and Council with respect to the identifica-
tion of—
‘‘(1) 
research 
priorities 
for 
projects 
on
osteoporosis, related bone disorders, and the care of
individuals with osteoporosis or related bone dis-
orders;
‘‘(2) emerging issues in and promising areas of
biomedical, clinical, and behavioral research on
osteoporosis and related bone disorders;
‘‘(3) emerging issues in research on health serv-
ices for individuals, and the families of individuals,
with osteoporosis or related bone disorders;
‘‘(4) emerging issues in home-based and com-
munity-based services and systems of services for in-
dividuals, and the families of individuals, with
osteoporosis or related bone disorders;
‘‘(5) emerging issues in financing health care
services and social services for individuals, and the
families of individuals, with osteoporosis and related
bone disorders;
‘‘(6) emerging issues in health promotion pro-
grams concerning osteoporosis; and
‘‘(7) emerging issues in professional and public
education concerning osteoporosis.
‘‘(c) CHAIRPERSON.—The Secretary shall appoint a
Chairperson of the Advisory Panel from among the mem-
bers appointed.
‘‘(d) TERM OF OFFICE.—The term of a member of
the Advisory Panel shall be for the life of the Advisory
Panel. A vacancy on the Advisory Panel shall be filled in
the same manner as the original appointment was made.
A vacancy on the Advisory Panel shall not affect its
powers.
‘‘(e) QUORUM.—A majority of the members of the
Advisory Panel appointed shall constitute a quorum, but
a lesser number may hold hearings. The Advisory Panel
may establish such subcommittees as the Advisory Panel
considers appropriate.
‘‘(f) MEETINGS.—The Advisory Panel shall meet at
the call of the Chairperson, but not less often than twice
per year.
‘‘(g) EXECUTIVE SECRETARY.—The Executive Sec-
retary of the Council shall serve as Executive Secretary
of the Advisory Panel.
‘‘(h) STAFF AND SUPPORT.—The Secretary shall pro-
vide the Advisory Panel with such additional administra-
tive staff and support as may be necessary to enable the
Advisory Panel to carry out its functions.
‘‘(i) COMPENSATION AND TRAVEL EXPENSES.—
‘‘(1) COMPENSATION.—Subject to paragraph
(2), no member of the Advisory Panel shall receive
compensation for service on the Advisory Panel.
‘‘(2) TRAVEL EXPENSES.—Each member of the
Advisory Panel shall receive reimbursement for trav-
el, subsistence, and other necessary expenses in-
curred in the performance of duties of the Advisory
Panel.
‘‘(j) REPORT.—The Advisory Panel shall—
‘‘(1) prepare an annual report, which shall con-
tain recommendations for administrative and legisla-
tive actions to—
‘‘(A) improve services, education, and in-
formation for individuals, and families of indi-
viduals, with osteoporosis and related bone dis-
orders;
‘‘(B) improve professional education; and
‘‘(C) provide for promising biomedical re-
search related to osteoporosis and related bone
disorders; and
‘‘(2) transmit the annual report to the Con-
gress, the Secretary, and the Council and make it
available to the public.
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section
$200,000 for each of fiscal years 1994 through 1996.
‘‘SEC. 442E. RESOURCE CENTER ON OSTEOPOROSIS AND
RELATED DISORDERS.
‘‘(a) ESTABLISHMENT.—The Director of the Na-
tional Institute of Arthritis and Musculoskeletal and Skin