[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1844 Introduced in House (IH)]

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Osteoporosis and Related 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 United States, not 
        including the costs of family care and lost work for 
        caregivers;
            (7) direct medical costs of osteoporosis are expected to 
        increase precipitously because the proportion 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 related 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 Diseases;
            (10) further research is needed to improve medical 
        knowledge concerning--
                    (A) cellular mechanisms related to the processes of 
                bone resorption and bone formation, and the effect of 
                different agents on bone remodeling;
                    (B) risk factors for osteoporosis, including newly 
                discovered risk factors, risk factors related 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, intake 
                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 Services.
            ``(4) Related disorders.--The term `related bone disorders' 
        includes--
                    ``(A) Paget's disease, a bone disease characterized 
                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 parathormone 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 characterized 
                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 Institute 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 Digestive and Kidney Diseases shall expand and 
intensify research on osteoporosis and related bone disorders. The 
research shall be in addition to research that is authorized under any 
other provision of law.
    ``(b) Research Centers.--The Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases shall increase the 
number of Specialized Centers of Research devoted to research on 
osteoporosis and related bone disorders. The Director of the National 
Institute on Aging shall increase the number of program project grants 
devoted to creating centers of excellence in osteoporosis and related 
bone disorders. The Director of the National Institute of Diabetes and 
Digestive and Kidney Diseases shall increase the number of program 
projects grants in osteoporosis.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $36,000,000 for the National 
Institute of Arthritis and Musculoskeletal and Skin Diseases, 
$24,000,000 for the National Institute on Aging, and $2,000,000 for the 
National Institute of Diabetes and Digestive and Kidney Diseases for 
each of the fiscal years 1994 through 1996, and such sums as may be 
necessary for subsequent fiscal years. These funds are in addition to 
amounts authorized to be appropriated for biomedical research relating 
to osteoporosis and related bone disorders under any other provision of 
law.

``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 Financing 
        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 Prevention 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 information on 
        osteoporosis and related bone disorders among all officers and 
        employees of the Department involved in carrying out programs 
        serving older persons, midlife women, and young persons, in 
        order to provide for full communication and exchange of 
        information;
            ``(3) review and coordinate the most promising areas of 
        research concerning osteoporosis and related bone disorders;
            ``(4) assist the National Institute of Arthritis and 
        Musculoskeletal and Skin Diseases, the National Institute on 
        Aging, the National Institute of Diabetes, Digestive and Kidney 
        Disease, the National Institute 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 division, 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 activities 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 research plans are 
                coordinated with, and use the resources of, other 
                Federal programs concerning osteoporosis and related 
                bone disorders, including--
                            ``(i) centers supported by the National 
                        Institute of Arthritis and Musculoskeletal and 
                        Skin Diseases, the National Institute on Aging, 
                        and the National Institute of Diabetes, 
                        Digestive and Kidney Disease;
                            ``(ii) other centers supported by Federal 
                        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 private foundations.
                    ``(C) Distribution.--The Executive Secretary 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 required 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 educational 
                        initiatives sponsored by the Federal Government 
                        on osteoporosis and related 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 RELATED DISORDERS.

    ``(a) Establishment.--There is established in the Department an 
Advisory Panel on Osteoporosis and Related 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 research 
                scientists with demonstrated achievement in biomedical 
                research on osteoporosis and related bone disorders, 
                including at least 1 researcher at a specialized center 
                for research in osteoporosis;
                    ``(B) 2 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 programs concerning 
                osteoporosis and related bone disorders;
                    ``(D) 2 members who are associated with specialized 
                bone programs affiliated with academic health centers;
                    ``(E) 2 members who are experts in private health 
                care insurance and long-term care financing; and
                    ``(F) 3 members who are representatives of national 
                voluntary organizations that are concerned 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 Diseases;
                    ``(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 Office of 
        Technology Assessment shall appoint members 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 identification of--
            ``(1) research priorities for projects on osteoporosis, 
        related bone disorders, and the care of individuals with 
        osteoporosis or related bone disorders;
            ``(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 services for 
        individuals, and the families of individuals, with osteoporosis 
        or related bone disorders;
            ``(4) emerging issues in home-based and community-based 
        services and systems of services for individuals, 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 programs 
        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 members 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 Secretary of the Council 
shall serve as Executive Secretary of the Advisory Panel.
    ``(h) Staff and Support.--The Secretary shall provide the Advisory 
Panel with such additional administrative 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 travel, subsistence, and other 
        necessary expenses incurred in the performance of duties of the 
        Advisory Panel.
    ``(j) Report.--The Advisory Panel shall--
            ``(1) prepare an annual report, which shall contain 
        recommendations for administrative and legislative actions to--
                    ``(A) improve services, education, and information 
                for individuals, and families of individuals, with 
                osteoporosis and related bone disorders;
                    ``(B) improve professional education; and
                    ``(C) provide for promising biomedical research 
                related to osteoporosis and related bone disorders; and
            ``(2) transmit the annual report to the Congress, 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 National Institute of 
Arthritis and Musculoskeletal and Skin Diseases shall make grants or 
enter into contracts with eligible organizations to establish a 
Resource Center on Osteoporosis and Related Disorders.
    ``(b) Purpose.--The purpose of the Resource Center shall be to 
facilitate and enhance knowledge and understanding of osteoporosis and 
related bone disorders by disseminating information about research 
results, services and educational materials, to health professionals, 
patients, and the public.
    ``(c) Functions.--An organization receiving a grant or contract 
under this section shall--
            ``(1) compile, archive, and disseminate information 
        concerning research, demonstration, evaluation, and training 
        programs and projects concerning osteoporosis and related bone 
        disorders;
            ``(2) annually publish a summary of the information 
        compiled under paragraph (1) during the preceding 12-month 
        period, and make the information available on request to 
        appropriate individuals and entities, including educational 
        institutions, research entities, and Federal and public 
        agencies;
            ``(3) provide information and assistance in accessing 
        community services to patients and the public;
            ``(4) coordinate regional training programs for the 
        development of health professional resource networks on 
        osteoporosis and related bone disorders; and
            ``(5) maintain a resource library on osteoporosis and 
        related bone disorders.
    ``(d) Information System and Telephone Line.--
            ``(1) Information system.--An organization receiving a 
        grant or contract under this section shall establish a central 
        computerized information system to--
                    ``(A) compile and disseminate information 
                concerning initiatives by State and local governments 
                and private entities to provide programs and services 
                for individuals with osteoporosis; and
                    ``(B) translate scientific and technical 
                information concerning the initiatives into information 
                readily understandable by the general public, and make 
                the information available on request.
            ``(2) Telephone line.--An organization receiving a grant or 
        contract under this section shall establish a national toll-
        free telephone line to make available the information described 
        in paragraph (1) and information concerning Federal programs, 
        services, and benefits for individuals with osteoporosis and 
        their families.
    ``(e) Fees.--In accordance with regulations issued by the 
Secretary, the organization receiving a grant or contract under this 
section shall charge appropriate fees for providing information through 
the Research Center as specified in subsections (c) or (d). The 
organization may make exceptions to the fees for individuals and 
organizations who are not financially able to pay the fees. The 
organization shall transfer the sums obtained from payment of the fees 
to the Secretary, who shall use the sums to carry out this section.
    ``(f) Application or Proposal.--In order to receive a grant or 
enter into a contract under this section, an organization shall submit 
an application or proposal to the Director of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases. The application or 
proposal shall contain--
            ``(1) information demonstrating that the organization has a 
        network of contacts that will enable the organization to 
        receive information necessary to operate the central 
        computerized information system described in subsection (d)(1); 
        and
            ``(2) such other information as the Director may prescribe.
    ``(g) Eligible Organizations.--Organizations eligible to receive 
grants under this section shall include public and private nonprofit 
organizations that are knowledgeable about osteoporosis and related 
bone disorders. The Secretary shall establish additional eligibility 
criteria for organizations to receive grants or enter into contracts 
under this section.
    ``(h) Research Summaries.--The Director of the National Institute 
of Arthritis and Musculoskeletal and Skin Diseases, the National 
Institute on Aging, the National Institute of Diabetes, Digestive, and 
Kidney Diseases, the National Institute on Dental Research, and other 
agencies specified by the Secretary shall provide to the Resource 
Center summaries of the findings of research conducted on osteoporosis, 
related bone disorders, or relevant treatments for osteoporosis or 
related bone disorders.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $500,000 for fiscal year 1994, 
and such sums as may be necessary for fiscal years 1995 and 1996.''.

                                 <all>

HR 1844 IH----2