A Framework for Action to Promote Bone Health

Remarks as prepared; not a transcript.

RADM Steven K. Galson, M.D., MPH
Acting U.S. Surgeon General
U.S. Department of Health and Human Services

Opening Remarks at Summit on Bone Health

June 26, 2008
Washington, DC

Thank you Ann, (Ann L. Elderkin P.A., Executive Director, American Society for Bone and Mineral Research) for that gracious introduction.

I am pleased be here, and I am honored to deliver opening remarks at this Summit.

The Summit agenda is both ambitious and impressive. I salute the National Coalition for Osteoporosis
and Related Bone Diseases (also known as the “Bone Coalition”) and your allies for everything you have done to make this event possible.

As Acting Surgeon General, I serve as our nation’s chief “health educator” - responsible for giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury,

That’s why events like this one, initially envisioned by the 2004 Surgeon General’s Report, are so important if we are to succeed in continually improving hone health.

I would describe the Summit another way as well.

If the 2004 “Surgeon General’s Report on Bone Health,” was a starting point and catalyst for improving bone health – which it certainly was – this Summit is a fitting “evolutionary successor” to it.

That said, I would like to commend certain individuals here today who contributed so greatly to the Report:

They are:

• Joan A. McGowan, Ph.D., National Institute of Arthritis, Musculoskeletal and Skin Diseases, The Report’sSenior Scientific Editor;
• Lawrence G. Raisz, M.D., University of Connecticut Health Center; (pronounced “royce”)
• Allan S. Noonan, M.D., M.P.H. then of the OSG, now dean of Morgan State University's School of Community Health and Policy, each of whom was a scientific editor, and
• Ann L. Elderkin, P.A. who honored me with such a wonderful introduction a moment ago, Managing Editor of the Report who today is Executive Director of the American Society for Bone and Mineral Research.

Because of your work, we are here today, poised to chart a path toward meaningful progress in addressing Osteoporosis, Paget’s Disease, Osteogenesis Imperfecta and other related bone diseases.

I should also point out that reducing the risk, prevalence and consequences of these and other bone diseases ‘fits in’ seamlessly with the broader public health objectives of my office.

As many of you here know, one of my foremost priorities is to promote disease prevention by helping Americans take actions to make themselves and their families healthier.

Another is improving health literacy – I’m talking about the ability of an individual to access, understand, and use information and services to make appropriate health decisions.

I’m don’t have to tell you that prevention should be our number #1 priority in health care - and you also know that we have a lot of work left to do in order to:

• move prevention more towards the mainstream in medicine.
• move prevention higher in our national medical investment list.
• make prevention part of every interaction between a public health professional and a patient.

Yet, as prevention relates to bone health, there is good news.

The news is that with appropriate nutrition and physical activity throughout life, individuals can significantly reduce the risk of bone disease and fractures.

Health professionals can also make significant improvements in our Nation’s bone health by:

• Pro-actively assessing, diagnosing, and treating at-risk patients
• Helping them apply this scientific knowledge in their everyday lives, improving health literacy in the process.

The pre-eminent objective of this Summit – to put together a national action plan to steadily increase awareness of osteoporosis and related bone diseases – focuses on improving health literacy regarding bone disease.

Leaving this meeting with an action plan and consensus on the necessary next steps is critical.

I am confident you will achieve this objective.

I know also that many other activities important to long-term improvements in bone health will be energized by the information exchange that takes place at this Summit.

Whatever the final form of the action plan, this much is certain:

In order to make and sustain systematic improvements in bone health, interventions will be necessary at multiple points of entry in our system of care.  These include interventions targeted to the following stakeholders:

• Individual clinician
• Medical group
• Hospital or post-acute facility
• Health plan or insurer
• Government & public health
• Voluntary health organizations & professional associations
• Academic institutions
• Health care purchaser
• Industry

Each of these sectors is represented at this Summit.

Their involvement and interactive discussions ensure, I think, that the action plan produced tomorrow will be thoughtful, comprehensive and “doable.”

In the interim, I am impressed by how far we - stakeholders and constituencies with a continuing interest in better bone health - have come.

The 2004 Report has been widely distributed.  It has helped increase public consciousness of bone health, and led to publication of bone health information pamphlets and guides to action accessible in multiple formats. 

I understand that the presentations to follow will describe more fully the breadth of interest in these products.

The underlying message common to these publications, which prompted the [AE1] 2004 Report, must drive deliberations at this Summit as well: act now, as we know more than enough.

The Future

It is that knowledge which should motivate us.

We know:

• the number of Americans with Osteoporosis and Low Bone Mass is expected to increase from 43.7 million in 2002 to 61.4 million in the year 2020,
• 1.5 million Americans suffer fractures as a result of osteoporosis every year, Reducing fractures is among objectives of Healthy People 2010.

I know that RADM Penny Royall, Deputy Secretary for Disease Prevention, will elaborate on these efforts during a presentation scheduled later this morning.

• We know another 500,000 people are hospitalized annually, and more than 3 million people receive care in emergency rooms or doctor’s offices as a result of osteoporosis.
• According to the National Institutes of Health, osteoporosis accounts for approximately $14 billion in direct costs for fractures annually.
• The National Osteoporosis Foundation estimates that, by 2025, these costs will increase to $25.3 billion and by 2030 will surpass $60 billion.
• A woman's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. Therefore a woman is more likely to experience hip fracture than these three forms of cancer.
• Men get osteoporosis, too. While 80 percent of those with osteoporosis are women, 20 percent are men.
• There are also reasons to be encouraged.

We understand the value of lifestyle changes - healthy eating, daily physical activity and fall prevention therapy - in reducing risk of bone disease.

At the same time, scientists are learning more about the pathways that affect what makes bones strong and healthy, and what factors make bones break down.

We also know more about the importance of vitamin D protein, iron, and other nutrients, in building and maintaining strong bones, and the potential consequences of vitamin D deficiency.

At least six FDA-approved medications and hormones can eliminate or slow bone loss, increase bone density, and decrease the risk of fractures.

Research has identified and demonstrated a variety of drugs that can reduce bone loss and fractures, and even build new bone.  Thirty years ago, there was no treatment for osteoporosis.

There is also a new approach to fracture risk assessment for clinicians, the FRAX calculator developed by the World Health Organization, which goes beyond measuring bone density to assess an individual’s risk for fracture and need for treatment.

While there are still some things to work out with the FRAX, it is a big step forward in our thinking about risk factors.

So, I am sure you will concur that there is ample reason for concern and cautious optimism.

Certainly, there is much at stake.

However, the benefits to be realized from success will be immense.

Again, we know more than enough to act now.

We know more than enough to redouble our commitment to translate bone health science into clinical practice as promptly as it emerges.

Time seldom waits, and it won’t wait on us; the aging of the American population underscores how important it is that we expeditiously move research to care.

Ultimately, as we succeed in improving bone health across the lifespan, we will have increased the years and quality of life of tens of thousands of people whose names we will never know.

I can scarcely imagine a greater reward.

Let us step up together and make this happen.