I 
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. HIG-
GINS, 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 Cali-
fornia, Mr. COHEN, Ms. SHEA-PORTER, Mr. ENGEL, Mr. WEXLER, Ms. 
CASTOR of Florida, Mrs. CHRISTENSEN, Ms. RICHARDSON, Mr. CROW-
LEY, 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. 
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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 ‘‘Bone Health Pro-
motion 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 mo-
bility, 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 Gen-
eral says that by 2020 one in two Americans over 
age 50 is expected to have or to be at risk of devel-
oping osteoporosis of the hip; even more will be at 
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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 frac-
tures. 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 pa-
tients 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 thera-
pies, such as chemotherapy and corticosteroids, have 
direct negative effects on bone. Also, certain cancers, 
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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 dis-
order 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 re-
duce 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 en-
couraged to: get enough calcium and vitamin D; en-
gage in regular weight-bearing and muscle-strength-
ening exercise; avoid smoking and excessive alcohol; 
and talk to their healthcare providers about bone 
health. 
(12) Greater efforts and commitments are need-
ed from Congress, the States, providers, and pa-
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tients to lessen the burden of osteoporosis and re-
lated 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 sec-
tion 314 the following: 
‘‘SEC. 315. NATIONAL BONE HEALTH PROGRAM. 
‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 
may develop and implement a National Bone Health Pro-
gram (in this section referred to as the ‘Program’) con-
sistent with this section. 
‘‘(b) 
CONTROL, 
PREVENTION, 
AND
SURVEIL-
LANCE.— 
‘‘(1) IN GENERAL.—Under the Program, the 
Secretary, acting through the Director of the Cen-
ters for Disease Control and Prevention, may, di-
rectly or through competitive grants to eligible enti-
ties, 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 dis-
eases. 
‘‘(2) TRAINING AND TECHNICAL ASSISTANCE.— 
With respect to the planning, development, and op-
eration of any activity carried out under paragraph 
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(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 pro-
viding grant funds under this subsection. 
‘‘(3) OSTEOPOROSIS AND RELATED BONE DIS-
EASE PREVENTION RESEARCH AT THE CENTERS FOR 
DISEASE
CONTROL
AND
PREVENTION.—The Sec-
retary may provide additional grant support under 
this subsection to encourage the expansion of re-
search 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 na-
tional public or private nonprofit entity that dem-
onstrates 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 
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education and outreach activities, directly or through 
the provision of grants to eligible entities, to sup-
port, 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 busi-
nesses and employers, managed care organizations, 
and health care providers. 
‘‘(3) PRIORITY.—In carrying out paragraph (1), 
the Secretary— 
‘‘(A) may emphasize prevention, early di-
agnosis, 
and 
appropriate 
management 
of 
osteoporosis and related bone disease, and op-
portunities for effective patient self-manage-
ment; and 
‘‘(B) may give priority to reaching high- 
risk or underserved populations. 
‘‘(4) COLLABORATION.—In carrying out this 
subsection, the Secretary shall consult and collabo-
rate with the Advisory Committee established in sub-
section (g). 
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‘‘(5) ELIGIBLE ENTITY.—For purposes of this 
subsection, the term ‘eligible entity’ means a na-
tional public or private nonprofit entity that dem-
onstrates 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 pro-
grams 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, assur-
ances, and information as the Secretary may re-
quire, including a comprehensive osteoporosis and 
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related bone disease control and prevention plan 
that— 
‘‘(A) is developed with the advice of stake-
holders 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 dis-
ability; 
‘‘(B) is intended to reduce the morbidity of 
osteoporosis and related bone diseases, with pri-
ority on preventing and controlling osteoporosis 
and related bone diseases in at-risk populations 
and reducing disparities in osteoporosis and re-
lated bone disease prevention, diagnosis, man-
agement, and quality of care in underserved 
populations; 
‘‘(C) describes the osteoporosis and related 
bone disease services and activities to be under-
taken or supported by the entity; and 
‘‘(D) demonstrates the relationship the en-
tity has with the community and local entities 
and how the entity plans to involve such com-
munity and local entities in carrying out the ac-
tivities described in paragraph (1). 
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‘‘(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 epide-
miological activities relating to the prevalence of 
osteoporosis and related bone disease and as-
sessment of disparities in osteoporosis and re-
lated bone disease prevention, diagnosis, man-
agement, and care; 
‘‘(B) public information and education pro-
grams; and 
‘‘(C) education, training, and clinical skills 
improvement activities for health professionals, 
including allied health personnel. 
‘‘(e) GENERAL APPLICATION.—To be eligible to re-
ceive 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 agree-
ments, assurances, and information as the Secretary may 
require, including a description of how funds received 
under a grant awarded under this section will supplement 
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or fulfill unmet needs identified in a comprehensive 
osteoporosis and related bone disease control and preven-
tion 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 Assist-
ance Act. 
‘‘(2) STATE.—The term ‘State’ means any 
State of the United States, the District of Columbia, 
the Commonwealth of Puerto Rico, the Virgin Is-
lands, 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 Cen-
ters for Disease Control and Prevention, shall estab-
lish a committee to be known as the Osteoporosis 
and Related Bone Disease Advisory Committee (re-
ferred to in this section as the ‘Advisory Com-
mittee’). The Advisory Committee shall be composed 
of at least one member, to be appointed by the Sec-
retary, acting through the Director of the Centers 
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for Disease Control and Prevention, representing 
each of the following: 
‘‘(A) National voluntary health organiza-
tions 
that 
focus 
on 
issues 
relating 
to 
osteoporosis or other bone diseases. 
‘‘(B) Professional societies that focus on 
issues relating to osteoporosis or other bone dis-
eases. 
‘‘(C) The Centers for Disease Control and 
Prevention, to include, upon the recommenda-
tion of the Director of the Centers, representa-
tives 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 Direc-
tor of the National Institutes of Health, rep-
resentatives of the National Institute of Arthri-
tis and Musculoskeletal and Skin Diseases, the 
National Cancer Institute, the National Insti-
tute of Biomedical Imaging and Bioengineering, 
the National Institute of Child Health and 
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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 re-
lating to osteoporosis or other bone disease con-
trol, 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; 
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‘‘(B) conduct and support national edu-
cation and outreach activities; 
‘‘(C) identify opportunities to coordinate 
efforts with other Federal and State agencies 
and private organizations addressing such dis-
eases; 
‘‘(D) ensure that public health policy deci-
sions and information disseminated to the pub-
lic and physicians are evidence-based and popu-
lation-focused; 
‘‘(E) advise relevant Federal agencies on 
priorities related to osteoporosis and related 
bone diseases; 
‘‘(F) conduct surveillance and data collec-
tion and disseminate epidemiological informa-
tion in accordance with section 32OB; and 
‘‘(G) expand and intensify research on 
osteoporosis and related bone diseases in ac-
cordance with section 404I. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
‘‘(1) for fiscal year 2010, $22,000,000; 
‘‘(2) for fiscal year 2011, $24,000,000; 
‘‘(3) for fiscal year 2012, $26,000,000; 
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‘‘(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 DIS-
EASES. 
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 ACTIVI-
TIES.— 
‘‘(1) IN GENERAL.—The Director of NIH shall 
expand and intensify programs of the National Insti-
tutes 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 Di-
rector of NIH shall carry out paragraph (1)— 
‘‘(A) in coordination with the directors of 
the National Institute of Arthritis and Musculo-
skeletal and Skin Diseases, the National Cancer 
Institute, the National Institute of Biomedical 
Imaging and Bioengineering, the National In-
stitute of Child Health and Human Develop-
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ment, 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 Wom-
en’s Health, and any other national research in-
stitutes or offices, as appropriate; and 
‘‘(B) in consultation with additional Fed-
eral officials, the advisory committee established 
under section 315(g), and any national vol-
untary health organizations, professional soci-
eties, and private entities, as appropriate. 
‘‘(b) PLANNING GRANTS AND CONTRACTS FOR INNO-
VATIVE 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 re-
search programs, or enhancement of existing re-
search programs, that focus on osteoporosis and re-
lated 
bone 
diseases, 
including 
osteogenesis 
imperfecta, Paget’s disease of bone, and rare bone 
diseases. 
‘‘(2) RESEARCH.— 
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‘‘(A) TYPES OF RESEARCH.—In carrying 
out this subsection, the Secretary shall encour-
age 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 collabo-
rative partnerships, which may include aca-
demic health centers, private sector entities, 
and nonprofit organizations. 
‘‘(C) NEW AND EARLY STAGE INVESTIGA-
TORS.—The Director of NIH shall make an ef-
fort to fund research by new and early stage in-
vestigators 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 addi-
tion to any authorization of appropriations under any 
other provision of law to carry out research activities on 
osteoporosis or related bone diseases.’’. 
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SEC. 5. SURVEILLANCE ACTIVITIES RELATED TO BONE DIS-
EASES AT THE CENTERS FOR DISEASE CON-
TROL 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 sec-
tion 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 Pre-
vention, 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 epidemiolog-
ical and other types of information obtained under sub-
section (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 inten-
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sification 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.’’. 
Æ 
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