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Testimony on Osteoporosis by Stephen I. Katz, M.D., Ph.D.
Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
U.S. Department of Health and Human Services

Before the Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies
May 20, 1998

Mr. Chairman and Members of the Subcommittee, I am Dr. Stephen Katz, Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the lead institute at the National Institutes of Health (NIH) for research on osteoporosis and related bone disorders. I am pleased to have this opportunity to testify before you today to highlight recent research advances and opportunities that relate to osteoporosis and related bone diseases and to the enhancement of bone health in general. I would like to leave you today with knowledge of how far research has brought us in understanding this disease and in providing us with critical clues about how to prevent this disease from impacting our lives and the lives of our families and friends. Osteoporosis does not need to be a consequence of aging. It is largely a preventable disease, and many research opportunities exist to enhance our knowledge about how to maintain a healthy skeleton throughout our lives.

Osteoporosis is the most prevalent of the bone diseases that affect Americans. It results in low bone mass and architectural abnormalities that contribute to bone fragility and increased fracture risk. Although it is the underlying cause of most fractures in older people, the condition is silent and undetected in most cases until a fracture occurs. A fracture is not a benign event, particularly in older people. The major fracture sites associated with osteoporosis are the hip, the spine, and the wrist. Of all the injury sites, hip fractures have the greatest morbidity and socioeconomic impact. Following a hip fracture, there is a 10-20 percent mortality rate during the next 6 months. This means people can and do die as a result of hip fractures. Fifty percent of those people experiencing a hip fracture will be unable to walk without assistance, and 25 percent will require long-term care.

Recently we gained insight into how many Americans are affected by osteoporosis through the National Health and Nutrition Examination Survey (NHANES). Conducted from 1988 to 1994, this survey measured the bone mineral density of a sample population across the United States and indicates that osteoporosis and low bone mass are common. For women, estimates indicate that 13 to 18 percent over the age of 50 have osteoporosis of the hip, and another 37 to 50 percent have low bone mass placing them at increased risk for developing osteoporosis as they age. Conservatively, this means that osteoporosis is a threat to more than 28 million Americans. The percentage of men affected is lower but still adds up to millions of men at risk of fractures. Although white women account for 75 percent of the approximately $14 billion cost of fractures in the United States, men and minority women are substantially vulnerable. The development of prevention and therapeutic strategies is critical given the impact of this problem in the United States.

Women are particularly vulnerable to getting osteoporosis. In the United States, women are four times as likely to develop osteoporosis as men. This is attributable to two factors: women have approximately a 10 percent lower peak bone mass by maturity, and they experience an accelerated bone loss after menopause. Although African American women have a considerably lower rate of osteoporosis and fractures, the NHANES data indicate that 10 percent of African American women over 50 have osteoporosis and 29 percent have low bone mass. While men are at a lower risk for osteoporosis than women, they are not exempt from this disease.

A great many research studies in osteoporosis and related bone diseases are underway at the NIH. In addition to the NIAMS, 13 other institutes, centers, and offices at the NIH are involved in research on osteoporosis and related bone diseases ranging from very basic studies to early intervention and prevention projects to clinical and translational research. Studies being conducted range from investigations of the causes and consequences of bone loss at cellular and tissue levels to clinical trials testing strategies to maintain and even enhance bone density. Evaluation of skeletal status is of major concern as scientists explore the roles of such factors as hormones, calcium, vitamin D, drugs, and exercise on bone mass. The influence of environmental factors (e.g., cadmium, lead, and boron) is also being examined.

Each NIH institute, center and office comes to the study of osteoporosis and related bone diseases from the vantage point of its individual and different mission. These efforts are both collaborative and complementary. For example, the NIAMS supports research across the spectrum from basic studies that are attempting to understand the normal functions of cells that build up and break down bone to clinical studies of the diagnosis, treatment, prevention, and epidemiology of osteoporosis and related bone diseases. The NIAMS bone biology and bone diseases programs not only provide improved understanding of osteoporosis, but also of other bone diseases such as Paget's disease, osteogenesis imperfecta, cancer metastasis to bone, and multiple myeloma. The National Institute on Aging (NIA) has unique lines of research that are derived from its mission to understand the aging processes and pathological changes that cause disability and compromise the quality of life in older people. The NIA supports a strong program of clinical studies of age-related bone loss and fracture epidemiology, intervention trials to prevent or reverse bone loss, and basic research studies on bone cell biology and the role of sex steroids, cytokines, and growth factors on bone cell function. NIA, in conjunction with the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women's Health (ORWH) supports a large multi-ethnic longitudinal study of women, aged 42-52 years, at five clinical field sites to evaluate mid-life changes on bone loss and the risk of osteoporosis as women approach and traverse the menopause. The National Institute of Dental Research (NIDR) supports a strong basic bone biology program with a focus on the connection between oral bone loss and osteoporosis. The NIDR also has an intramural program that researches normal bone growth and turnover as well as the pathophysiological mechanisms of brittle bone diseases, including the hereditary disease osteogenesis imperfecta. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides support for research on nutrition and endocrinology, including the hormones regulating bone metabolism. The National Institute of Child Health and Human Development (NICHD) supports research to enhance understanding of how to prevent this disease by influencing the behaviors of children in such areas as diet and exercise, and supports studies in reproductive endocrinology and the possible impact of hormones and reproductive history on the etiology of osteoporosis. In addition, through the NICHD intramural program, studies are conducted on the genetics, growth, and rehabilitation of children with heritable disorders of connective tissue such as osteogenesis imperfecta. The National Institute of Environmental Health Sciences (NIEHS) research focuses on metals such as cadmium, lead, and boron found in the environment as risk factors in development of the disease. The NIH Office of Research on Women's Health has made a vital contribution to osteoporosis research through supplemental grants and the Director's leadership role in the Women's Health Initiative (WHI). The WHI project is led by the National Heart, Lung, and Blood Institute and coordinated with the NIAMS, the NIA, and the National Cancer Institute. This project contains the largest test of the effect of hormone replacement therapy and calcium and vitamin D supplementation on osteoporosis.

Osteoporosis and related bone diseases are complex, and their study reflects a multiplicity of interests. To provide coordination and to enhance cooperative research and education activities across agencies, the NIAMS launched the Federal Working Group on Bone Diseases (FWGBD) in 1993. As Director of the NIAMS, I chair the FWGBD, whose membership includes not only representation from the NIH institutes, centers and offices, but also other Federal agencies including the Agency for Health Care Policy and Research, the Department of Defense (DOD), the National Aeronautics and Space Administration (NASA), and the Public Health Service (PHS) Office on Women's Health. I have attached to my statement a list of all NIH components and Federal agencies represented on the FWGBD. The FWGBD meets regularly throughout the year and provides a structure for information sharing, formulation of collaborative research efforts, and coordination of osteoporosis research across all Federal agencies with an interest in bone diseases and bone health.

Outside of the DHHS, the NASA and the DOD have supported osteoporosis and related bone diseases research over the past several years. The NASA's interests relate to what happens to bone in a reduced-gravity environment. The depletion of bone and muscle while in space is a significant risk to astronauts. Exposure to reduced gravity during space travel profoundly alters the load placed on bone and muscle, and thereby has direct effects on the tissues. The DOD initiated an osteoporosis program in 1995, and this expanded in 1997 with grants solicited in the area of mechanical stimulation of bone growth, focussing on military preparedness in a physically active population. The NIAMS program and review staff helped with the planning of the solicitation of application and with their review.

With this as background on the importance of a broad multipronged approach to targeting osteoporosis and related bone diseases, I would like to focus my remaining testimony on research highlights, advances, and opportunities. Specifically I will address (1) the importance of identifying prevention, early intervention, and assessment/diagnostic tools to reduce the prevalence of osteoporosis; (2) recent breakthroughs in basic research leading to improved understanding of bone formation and the role genetics in predisposing one to osteoporosis, (3) the status of treatments for this disease; and (4) a summary of exciting research opportunities.


Prevention of Osteoporosis Through Diet and Physical Exercise This is an exciting time for research related to osteoporosis and bone health. There has been a revolution in thinking about osteoporosis over the last decade. The most significant insight comes from the recognition that osteoporosis and fractures are not a natural consequence of aging. NIH support for clinical studies of nutrition and physical activity interventions has provided strong evidence that fractures can be prevented and bone loss reduced even in older individuals. We have learned a great deal about the need to build bone across the life span, beginning at a very young age. Most significantly, we have learned that rapid bone acquisition occurs before, but also at and after puberty, and this period is crucial in skeletal development and critical for the prevention of osteoporosis later in life.

This past August, the Institute of Medicine (IOM) completed a study of calcium and related nutrients. The goal was to provide an update of the dietary information published in 1989 as the Recommended Dietary Allowances (RDAs). This IOM study follows and in many ways parallels the successful 1994 NIH Consensus Development Conference on Optimal Calcium Intake. Key calcium metabolic studies supported by the NIH made it possible for the Consensus Conference and the IOM to approach the issue of optimizing calcium intakes, not only to prevent deficiency diseases, but to build a better skeleton and to preserve it throughout life.

The primary data used for setting adequate intakes for children 9 through 18 years of age are derived from careful and innovative metabolic studies estimating the intakes necessary to achieve maximal calcium retention in the body. The NIH has supported several studies of calcium in young girls. In one such study, young girls have attended "Camp Calcium" where careful calcium balance studies that require several weeks to be completed are carried out on the Purdue University Campus in a sorority house where the girls have fun and see how scientists work.

Understanding the role of calcium absorption and vitamin D intake in pre- and postmenopausal women is also extremely important to maximizing bone health later in life. Critical long-term studies with a major impact on the field of calcium nutritional physiology have been conducted with NIH support that began in the late 1960's. Investigators have followed a cohort of Catholic nuns for more than 30 years from early premenopause up through their early seventies, thus far. Results emanating from the "Nuns' Study" have described the changes in calcium balance with age, hormone status, and vitamin D intake and have also contributed to our understanding of calcium absorption from different food sources (milk vs. vegetables) and from different types of supplements. This study and others indicate that adequate calcium intake may prevent bone loss, decrease the prevalence of osteoporosis, and prevent fractures in the elderly.

While the progress to date has clearly been impressive, the story is not complete. The largest study of osteoporosis and fractures ever conducted is now underway as part of the NIH Women's Health Initiative. Hip fractures are the most devastating consequence of osteoporosis, but testing the effectiveness of calcium and vitamin D in preventing hip fractures requires a large number of women over a long period of time (8 years). This study will determine what can be achieved with calcium and vitamin D supplements and may lead to new public health initiatives to optimize the intake of these nutrients in the U.S. population.

Identification of Risk Factors for Hip Fractures in Women

The NIAMS and the NIA cooperatively support the Study of Osteoporotic Fractures (SOF), a study that followed more than 9,000 women for over 10 years in order to determine what risk factors are associated with hip fractures and especially which ones are preventable. Results of this study have shown that one in every six white woman will have a hip fracture in her lifetime; thus identifying preventable risks can make an enormous impact on preventing disability in older women. Some prominent and modifiable risk factors identified in this study that increase the chance of hip fracture are poor visual acuity, especially poor depth perception and contrast sensitivity; weight loss after age 25; more than two cups of coffee a day; no walking for exercise; being on one's feet less than 4 hours a day; and the use of some medications such as long-acting benzodiazepines and anticonvulsant drugs. Clearly an increase in physical activity, an eye checkup and a review of medications can do a lot to prevent hip fractures.

Identification of Risk Factors for Hip Fractures in Men

Although 50-year-old white men have about a 13 percent lifetime risk of fractures of the hip, spine, or wrist, the causes of and mechanisms involved in osteoporosis in men have received little research attention to date. Men develop osteoporosis and osteoporotic fractures about a decade later than women do. This has been attributed to a higher peak bone mass at maturity and a more gradual diminution in sex steroid influence in aging men. At each age, the rate of hip fracture in men is about 50 percent that in women. With the decline in premature cardiovascular mortality in men, fractures later in life are becoming an increasingly important cause of morbidity and mortality in older men. In a recent study, risk factors thought to affect bone density (weight, smoking, physical activity, some drugs) as well as factors identified as risk factors for falls (lower limb dysfunction, psychotropic drugs) appear to be important determinants of the risk of hip fracture in men. Physical activity may be a particularly promising preventive measure for men and can favorably influence other chronic diseases such as heart disease.

Assessment and Diagnostic Tools

As new treatment strategies become available, it becomes critical to be able to assess skeletal health to identify those in need of intervention as well as to determine the effectiveness of particular treatments. The development of new technology to measure bone mineral density as well as bone quality is an active focus of research. Ultrasound technology is emerging as an alternative to bone densitometry for some clinical applications. It is faster, cheaper, and without the radiation exposure of conventional bone densitometry devices. Studies are also underway to develop blood and urine tests that may one day be used to screen for osteoporosis.

Prevention Through Public Education Campaigns

As stated many times throughout this testimony, prevention of osteoporosis is the key to reducing the risk of this disease for men and women in later life. Because the window of opportunity to add bone to the skeleton is limited, educational strategies are extremely important, for example, encouraging calcium intake by children and adolescents at the recommended levels and encouraging regular exercise. Likewise, strategies to encourage regular exercise, especially weight-bearing activities, discourage smoking and limit alcohol consumption across the life span are important to maintaining optimal bone health. Equally important are educational strategies designed to inform those most at risk of developing osteoporosis of the modifiable risk factors and available diagnostic tools so that early intervention is possible.

The NIAMS supports the Osteoporosis and Related Bone Diseases--National Resource Center (ORBD~NRC). The Center is currently operated by the National Osteoporosis Foundation (NOF) in partnership with The Paget Foundation and the Osteogenesis Imperfecta Foundation under a grant from the NIAMS. The Center provides patients, health professionals, and the public with resources and information on osteoporosis and related bone disorders. Information on prevention, early detection, treatments, and coping strategies is disseminated widely through publications, online services, professional and patient meetings, and general media outreach. The NIAMS, along with several other NIH institutes including the NIA, the NICHD, the NIDR, the NIEHS, and the Office of Research on Women's Health, has issued a Request for Applications (RFA) inviting applications to continue support for such a center.

The NIAMS has collaborated with the PHS Office on Women's Health, the NOF through the Osteoporosis Resource Center and the Centers for Disease Control and Prevention (CDC) to enhance the strategies to promote bone health for women. The National Osteoporosis Education Campaign will first focus on 9-12 year old girls, just approaching their peak bone building years, but as the campaign develops, it will expand to cover 13-18 year old girls. The goal is to develop strategies for effectively reaching this age range so as to influence life-long healthy bone behaviors.

"Milk Matters" is another public health campaign led by the NICHD. It is designed to increase calcium consumption among children and teens. Studies show that most kids are not getting adequate levels of calcium during this critical period when bones grow and incorporate calcium most rapidly. The "Milk Matters" campaign works to reach children and teens, as well as parents and health care professionals, with the message that increased calcium and weight-bearing exercise during the first two decades of life can be critical to good health as an adult.


Bone Formation and Breakdown Treatments for osteoporosis and further information on preventive strategies for osteoporosis and related bone diseases will come from basic studies on understanding the genetics of bone formation and the process of bone loss and remodeling. Bone is constantly being built up and broken down. As evidenced by what has been learned about the role of calcium, we try to build bone up as much as possible with calcium in the early years because this serves as a storage bank for later years. Enhancement of cells that build bone (osteoblasts) and interference with cells that break down bone (osteoclasts) tend to result in sturdier bones. All of our achievements and future progress in osteoporosis and other bone diseases, such as Paget's disease and osteogenesis imperfecta, are based on understanding the normal functions of bone cells and investigating strategies to manipulate the normal physiology of bone for therapeutic advantage. Likewise, new insights into the control of bone remodeling by bisphosphonates (chemicals that block resorption of bone) have led to approaches to controlling the skeletal complications of malignancy.

Genetics of Bone Formation

In an exciting convergence of efforts by investigators around the world, a gene essential for the formation of bone has been identified. Researchers made two key observations: First, mice in which both copies of the Cbfa1 gene have been inactivated exhibit a complete lack of bone and bone-forming cells and die at an early age. Thus, the Cbfa1 protein appears to function as a "master switch" for bone formation. Second, mice in which one of the two Cbfa1 genes was inactivated exhibited a combination of specific skeletal defects that closely resembled those seen in a heritable human disorder called cleidocranial dysplasia, which is characterized by defective bone formation. Consistent with this evidence from mice, genetic studies in families with cleidocranial dysplasia showed that the disorder is associated with mutations in the human Cbfa1 gene. Thus, in order for normal skeletal development to occur in both mice and humans, the Cbfa1 protein must be present in amounts that can be provided only by two active copies of the gene. The discovery of the critical role of Cbfa1 in bone formation opens a number of exciting new research areas.

Understanding the role of genetics in predisposing one to osteoporosis is a very important area of research. Bone mass at any point in life represents a balance between the amount of bone accumulated during growth and development and the amount of bone lost with aging. Studies using families, particularly twins, indicate that bone mass and osteoporosis may be due to an inherited trait in some families. Resolving the genetic underpinnings of a complex trait in humans is difficult, because human populations are genetically diverse. Thus, current efforts include studies of the genetics of bone mass in animals such as mice, in which selective breeding can reduce the complexity of the problem. Because both bone metabolism and genetic organization exhibit parallels across mammalian species, it is expected that the results of the animal studies will provide important guidance to further efforts in human populations.

Several human candidate genes have been examined for their regulatory effect on bone mass including those for collagen type I, estrogen and vitamin D. A great deal of work has focused on the vitamin D receptor (VDR) gene, and experience with this locus will probably act as a model for many future studies. There is increasing evidence of a complex interaction between this gene and environmental factors in the regulation of bone mass. Moreover, it is clear that bone mass and density are influenced by many genes (mostly unknown) and a complex interaction with environmental factors such as nutrition and physical activity.

Interactions of Bone and the Hematopoietic and Immune Systems as Consequences for Skeletal Health

Bones are not only a crucial mechanical support for our bodies, they also enclose the bone marrow, the site of the process called hematopoiesis, in which blood cells are produced, including the many different cells of the immune system. Interactions among bone cells, hematopoietic cells, immune cells, and other cells of the marrow environment can have important consequences for skeletal health. In August of 1997, the NIAMS and several other NIH components sponsored a scientific workshop entitled "Bone and the Hematopoietic and Immune Systems" that brought together over 200 bone biologists, hematologists, immunologists, and physicians for 2 days of scientific presentations and discussions. As a result, a number of areas have been identified in which further research seems especially important. Future efforts seem likely to be particularly rewarding if they can either clarify the importance of specific cell types and effector molecules or identify previously unrecognized cellular and molecular agents that influence bone physiology.

Examples of important areas of pursuit include (1) the determination of mechanisms that regulate the differentiation of different bone cell types, including the nature of stem cells and factors that govern their development, and (2) the identification of other bone marrow cell types, such as hematopoietic cells and stages of lymphoid and myeloid differentiation, that may influence bone cells. The development and application of treatments for conditions of bone loss, such as osteoporosis and for rarer conditions of bone formation, depend upon a thorough understanding of the factors that control the breakdown and formation of bone. It is likely that bone cells do not function in isolation, but instead respond to a complex mixture of influences arising in part from immune, hematopoietic, and stromal cells. Understanding these influences may identify targets for new bone-active agents, and may help to explain the complex effects of agents already in use.


Although there is no cure for osteoporosis, there are now several effective therapies to help stop further bone loss and potentially prevent future fractures. Studies have shown that estrogen can prevent the loss of bone in postmenopausal women; however, many questions remain about the effect of estrogen on other tissues in the body. The questions about estrogen have led to the development of a new class of drugs called Selective Estrogen Receptor Modulators (SERM's). The hope is to produce a drug with all the positive effects of estrogen on bone and lipids and not to stimulate the activity of the breast or the uterus. Tamoxifen is a SERM that has recently been shown to reduce the risk of breast cancer in women at high risk. Another SERM, raloxifene has recently been approved by the Food and Drug Administration (FDA) for the prevention of osteoporosis.

Alendronate, a bisphosphonate, has recently been approved by the FDA for treatment of postmenopausal osteoporosis. This class of drug targets bone specifically, reducing bone breakdown and decreasing fractures in older women. These are very promising avenues of development and will undoubtedly lead to even more choices for postmenopausal women.

NIH-supported studies of the underlying pathophysiologic mechanisms of bone loss and remodeling as well as the development of animal and cellular models, have made new drug approaches possible. These approaches are crucial to determine the underlying mechanisms of action of drugs and to devise alternative therapies. In recent research results investigators have shown that estrogen induces programmed cell death in osteoclasts which are responsible for the degradation of bone. This discovery opens up an exciting new avenue of research opportunities for investigators to explore whether other drugs can also affect the programmed cell death of osteoclasts, making them potentially useful as bone-protecting treatments.


Numerous research opportunities exist to alter the increasing occurrence of osteoporosis. In the past decade, there has been an explosion of fundamental and clinical research in osteoporosis. Large epidemiological studies have identified risk factors for low bone mass and fractures. Clinical studies have pointed to the efficacy of calcium and vitamin D supplementation in a subset of elderly women, and physical activity has been associated with decreased bone loss and improved musculoskeletal stature and balance. There are many fundamental advances in molecular and cellular biology, immunology, genetics, and bioengineering that have not yet been applied to skeletal biology. Many opportunities exist to build on and expand the current knowledge base.

Basic Research

Details are beginning to emerge about the complex network of signaling mechanisms that control bone growth and maintain skeletal integrity. Specific probes have made it possible to identify new molecules responsible for the local and systemic regulation of bone cell function, as well as the cell surface molecules and linked signal transduction pathways that mediate their effect. Research opportunities exist to better understand osteoclasts and osteoblasts, cells that are essential for bone remodeling. Furthermore, the complex relationship between the bone microenvironment and the immune system demands attention. Evidence is accumulating to indicate that regulation of the immune system operates on common principles and employs common effectors.

The identification, mapping, and structural analysis of genes with crucial functions in the regulation of bone are increasingly feasible research goals. The use of genetically manipulated animals allows investigators to test the effects of specific gene inactivation or overexpression. The identification of genetic variations in the human population that underlie different vulnerabilities to bone loss is made possible by the increasing knowledge of the human genome and advancing molecular screening technology. While several candidate genes have been identified in osteoporosis, the complete picture will require both human and population genetics and further animal studies. The study of the genetics of osteoporosis is likely to yield insights into the pathophysiology of the disease and clues for targeting interventions.

Behavior Modification and Education Research

Translating knowledge to behavior change is extremely difficult. While current evidence indicates that there are effective dietary, exercise, and lifestyle guidelines that one can follow to increase peak bone mass and promote long-term bone health, translating this message into changed behavior is a challenge. Research targeted at identifying promising health education approaches that enhance awareness and knowledge for young and adolescent females is needed. Similarly, education messages targeted to postmenopausal women that identify risk factors, promote regular exercise and physical activity, and discuss intervention and treatment strategies are critical as well. Imp

roved Diagnostic and Assessment Tools

The establishment of new diagnostic procedures that provide insight into the structural defects in diseased bone and allow a means to assess bone strength is an important area of research. Currently, the approaches to the assessment of osteoporosis are largely limited to measurement of bone density, for example, dual energy x-ray absorptiometry (DXA). While these methods are good predictors of future fractures, they do have their limitations in accuracy and precision. One significant limitation is that they do not provide insight to the underlying abnormalities in osteoporotic bone. Bone mass and architecture together determine the resistance of bone to fracture. New technologies are being developed to evaluate the contribution of architecture in vivo. These new methods may include variations of micro-computed tomography or magnetic resonance imaging (MRI) techniques.

One alternative diagnostic technique recently approved by the FDA is ultrasound. With ultrasound, different properties of bone can be measured, reflecting mechanical quality, an important determinant of bone strength. Biochemical markers of bone turnover offer yet another technique for assessment of osteoporosis. These measurements may add to the ability to assess the pathophysiological basis for the disorder and the effects of therapy. However, biological variability limits the utility of these measures to population screening, and they are not yet applicable to detailed evaluation of an individual patient.

New Improved Treatments

Bisphosphonates that target bone and reduce bone loss and fractures have been approved for osteoporosis treatment and prevention. These new agents may also have promise in reducing the skeletal complications of malignancy. Estrogen replacement therapy has been clearly shown to effectively retard bone loss in postmenopausal women. However, it has effects on multiple organ systems and is not without risk. The new selective estrogen receptor modulators that have been developed appear to lessen bone loss in postmenopausal women without the adverse effects on other organs. Fundamental research on estrogen receptors and their target organs fuel the development of these new agents.

In closing, I hope that I have increased the Committee's awareness of the tremendous progress we have made through research in understanding the fundamentals of bone biology and how to prevent and treat osteoporosis. Our objectives over the next decade are to stimulate new fundamental research, to translate advances in other fields to bone biology, to move basic/fundamental research to clinical application, to enhance the uptake of research knowledge by the public, especially the population most at risk of osteoporosis, and to apply this knowledge to develop effective preventive strategies. Our goal in osteoporosis and other musculoskeletal diseases that are our research focus is to reduce the burden of disability and enhance the lives and contributions of the populations who suffer from these chronic musculoskeletal disorders.

I would be happy to answer any questions that you may have regarding osteoporosis research.


Federal Member Organizations
  • National Institutes of Health:
    • National Institute of Arthritis and Musculoskeletal and Skin Diseases
    • National Institute of Child Health and Human Development
    • National Institute of Environmental Health Sciences
    • National Institute of Diabetes and Digestive and Kidney Diseases
    • National Cancer Institute
    • National Institute of Dental Research
    • National Institute on Aging
    • National Institute of Nursing Research
    • National Institute on Alcohol Abuse and Alcoholism
    • National Center for Research Resources
    • Office of Research on Women's Health

  • Other Federal Agencies:
    • Agency for Health Care Policy and Research/Forum for Quality and Effectiveness of Health Care
    • Health Care Financing Administration/Office of Research and Demonstration
    • Department of Agriculture/Human Nutrition Research Center
    • Department of Defense/Army Operational Research Program
    • Centers for Disease Control and Prevention
    • National Center for Chronic Disease Prevention and Health Promotion
    • National Center for Health Statistics
    • Food and Drug Administration/Division of Metabolism and Endocrine Drug Products
    • Department of Education/National Institute on Disability and Rehabilitation Research
    • National Aeronautics and Space Administration/Life and Biomedical Sciences Applications Division

Liaison Organizations/Federal and Non-Federal:
  • NIH Office of Disease Prevention

  • NIH Clinical Center Nursing Department

  • NIH Nutrition Coordinating Committee

  • U.S. Department of Health and Human Services

    • Office on Women's Health

    • Administration on Aging

  • Osteoporosis and Related Bone Diseases National Resource Center

  • National Osteoporosis Foundation

  • The Paget Foundation

  • American Society for Bone and Mineral Research

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