I
105TH CONGRESS
1ST SESSION
H. R. 2697
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 diseases.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 22, 1997
Ms. EDDIE BERNICE JOHNSON of Texas (for herself, Mrs. MALONEY of New
York, Mrs. MORELLA, Ms. WOOLSEY, Mr. PASCRELL, Mr. DELLUMS, and
Mr. DINGELL) introduced the following bill; which was referred to the
Committee on 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 diseases.
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 Diseases Research Act of 1997’’.
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) osteoporosis is a threat to an estimated
28,000,000 Americans, 80 percent of whom are
women, many of whose cases go undiagnosed be-
cause 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,
hyperparathyroidism, and other related metabolic
bone diseases;
(4) osteoporosis is responsible for 1,500,000
bone fractures annually, including more than
300,000 hip fractures, 700,000 vertebral fractures,
200,000 fractures of the wrist, and the remaining
fractures at other sites;
(5) 1 of every 2 women and 1 of every 8 men
over age 50 will develop fractures associated with
osteoporosis in their lifetimes;
(6) direct medical costs of osteoporosis are esti-
mated to be $13,800,000,000 annually 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 diseases is severely constrained at key re-
search institutes, including the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, the
National Institute on Aging, the National Institute
of Diabetes and Digestive and Kidney Diseases, the
National Institute of Dental Research, and the Na-
tional Institute of Child Health and Human Devel-
opment;
(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), risk factors related to
genes that help to control skeletal metabolism,
and risk factors relating to the relationship of
aging 
processes 
to 
the 
development 
of
osteoporosis;
(C) bone mass measurement technology,
including more widespread and cost-effective
techniques for making more precise measure-
ments and for interpreting measurements;
(D) calcium (including bioavailability, in-
take requirements, and the role of calcium in
building heavier and denser skeletons), and vi-
tamin D and its role as an essential vitamin in
adults;
(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 by adding
at the end the following new section:
‘‘RESEARCH ON OSTEOPOROSIS AND RELATED DISEASES
‘‘SEC. 442A. (a) EXPANSION OF RESEARCH.—The
Director of the Institute, the Director of the National In-
stitute on Aging, the Director of the National Institute
of Diabetes and Digestive and Kidney Diseases, the Direc-
tor of the National Institute of Dental Research, and the
Director of the National Institute of Child Health and
Human Development shall expand and intensify research
on osteoporosis and related bone diseases. The research
shall be in addition to research that is authorized under
any other provision of law.
‘‘(b) MECHANISMS FOR EXPANSION OF RESEARCH.—
Each of the Directors specified in subsection (a) shall, in
carrying out such subsection, provide for one or more of
the following:
‘‘(1) Investigator-initiated research.
‘‘(2) Funding for investigators beginning their
research careers.
‘‘(3) Mentorship research grants.
‘‘(c) SPECIALIZED CENTERS OF RESEARCH.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute, after consultation with the advisory council for
the Institute, shall make grants to, or enter into
contracts with, public or nonprofit private entities
for the development and operation of centers to con-
duct research on osteoporosis and related bone dis-
eases. Subject to the extent of amounts made avail-
able in appropriations Acts, the Director shall pro-
vide for not less than three such centers.
‘‘(2) ACTIVITIES.—Each center assisted under
this subsection—
‘‘(A) shall, with respect to osteoporosis and
related bone diseases—
‘‘(i) conduct basic and clinical re-
search;
‘‘(ii) develop protocols for training
physicians, scientists, nurses, and other
health and allied health professionals;
‘‘(iii) conduct training programs for
such individuals;
‘‘(iv) develop model continuing edu-
cation programs for such professionals;
and
‘‘(v) disseminate information to such
professionals and the public;
‘‘(B) may use the funds to provide stipends
for health and allied health professionals en-
rolled in training programs described in sub-
paragraph (A)(iii); and
‘‘(C) shall use the facilities of a single in-
stitution, or be formed from a consortium of co-
operating institutions, meeting such require-
ments as may be prescribed by the Director of
the Institute.
‘‘(3) DURATION
OF
SUPPORT.—Support of a
center under this subsection may be for a period not
exceeding 5 years. Such period may be extended for
one or more additional periods not exceeding 5 years
if the operations of such center have been reviewed
by an appropriate technical and scientific peer re-
view group established by the Director and if such
group has recommended to the Director that such
period should be extended.
‘‘(d) DEFINITION OF RELATED BONE DISEASES.—
For purposes of this section, the term ‘related bone dis-
eases’ includes—
‘‘(1) Paget’s disease, a bone disease character-
ized by enlargement and loss of density with bowing
and deformity of the bones;
‘‘(2) osteogenesis imperfecta, a familial disease
marked by extreme brittleness of the long bones;
‘‘(3) hyperparathyroidism, a condition charac-
terized by the presence of excess parathormone in
the body resulting in disturbance of calcium metabo-
lism with loss of calcium from bone and renal dam-
age;
‘‘(4) hypoparathyroidism, a condition character-
ized by the absence of parathormone resulting in
disturbances of calcium metabolism;
‘‘(5) renal bone disease, a disease characterized
by metabolic disturbances from dialysis, renal trans-
plants, or other renal disturbances;
‘‘(6) primary or postmenopausal osteoporosis
and secondary osteoporosis, such as that induced by
corticosteroids; and
‘‘(7) other general diseases of bone and mineral
metabolism including abnormalities of vitamin D.
‘‘(e) AUTHORIZATIONS OF APPROPRIATIONS.—
‘‘(1) NATIONAL INSTITUTE OF ARTHRITIS AND
MUSCULOSKELETAL AND SKIN DISEASES.—For the
purpose of carrying out this section through the Na-
tional Institute of Arthritis and Musculoskeletal and
Skin Diseases, there are authorized to be appro-
priated $17,000,000 for each of the fiscal years
1999 through 2001, and such sums as may be nec-
essary for each subsequent fiscal year.
‘‘(2) NATIONAL INSTITUTE ON AGING.—For the
purpose of carrying out this section through the Na-
tional Institute on Aging, there are authorized to be
appropriated $10,000,000 for each of the fiscal
years 1999 through 2001, and such sums as may be
necessary for each subsequent fiscal year.
‘‘(3) NATIONAL INSTITUTE OF DIABETES AND
DIGESTIVE AND KIDNEY DISEASES.—For the pur-
pose of carrying out this section through the Na-
tional Institute of Diabetes and Digestive and Kid-
ney Diseases, there are authorized to be appro-
priated $10,000,000 for each of the fiscal years
1999 through 2001, and such sums as may be nec-
essary for each subsequent fiscal year.
‘‘(4) NATIONAL
INSTITUTE
OF
DENTAL
RE-
SEARCH.—For the purpose of carrying out this sec-
tion through the National Institute of Dental Re-
search, there are authorized to be appropriated
$5,000,000 for each of the fiscal years 1999 through
2001, and such sums as may be necessary for each
subsequent fiscal year.
‘‘(5) NATIONAL INSTITUTE OF CHILD HEALTH
AND HUMAN DEVELOPMENT.—For the purpose of
carrying out this section through the National Insti-
tute of Child Health and Human Development, there
are authorized to be appropriated $5,000,000 for
each of the fiscal years 1999 through 2001, and
such sums as may be necessary for each subsequent
fiscal year.
‘‘(6) SPECIALIZED CENTERS OF RESEARCH.—
For the purpose of carrying out subsection (c), there
are authorized to be appropriated $3,000,000 for
each of the fiscal years 1999 through 2001, and
such sums as may be necessary for each subsequent
fiscal year.
‘‘(7) RELATION TO OTHER PROVISIONS.—Au-
thorizations of appropriations under this subsection
are in addition to amounts authorized to be appro-
priated 
for 
biomedical 
research 
relating 
to
osteoporosis and related bone diseases under any
other provision of law.’’.
Æ