National Bone Health Alliance: An Innovative Public-Private Partnership Improving America’s Bone Health
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- Lee, D.B., Lowden, M.R., Patmintra, V. et al. Curr Osteoporos Rep (2013) 11: 348. doi:10.1007/s11914-013-0159-y
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The U.S. National Bone Health Alliance (NBHA) is a public-private partnership launched in 2010 that brings together its 56 partners from the government, nonprofit, and for-profit sectors to collectively promote bone health and prevent disease; improve bone disease diagnosis and treatment; and enhance bone research, surveillance, and evaluation. NBHA is driven to achieve its 20/20 vision to reduce fractures 20 % by the year 2020 through projects including 2Million2Many, an osteoporosis awareness campaign; Fracture Prevention CENTRAL, an online resource center providing support to sites interested in launching a secondary fracture prevention program; bone turnover marker standardization project; and working groups in rare bone disease and the clinical diagnosis of osteoporosis. NBHA provides a platform to coordinate messaging among individuals and organizations on subjects important to bone health; pool funding and efforts around shared priorities; and work together towards the goals and recommendations of the National Action Plan on Bone Health.
KeywordsNational Bone Health AllianceOsteoporosisFracturesFallsBone healthBone breaksNBHABone diseaseVitamin DCalciumDXADensitometryBoneFracture prevention centralRare bone diseaseDXA reimbursementFracture liaison serviceBone turnoverBone density testSecondary fracture prevention
Bone Health and Osteoporosis: A Report of the Surgeon General (2004) : called for public and private stakeholders to join forces to develop a national action plan on bone health.
National Action Plan for Bone Health (2008) : Convened as a follow-up to the recommendations from the Surgeon General’s Report on Bone Health and Osteoporosis, more than 150 bone health stakeholders, ranging from families and healthcare professionals to government, industry, and academic institutions, came together for the Summit in June 2008. The group specified 4 priority areas: develop a bone health alliance; promote bone health and prevent disease; improve diagnosis and treatment; and enhance research, surveillance, and evaluation.
From those 2 activities, NBHA was born and was officially launched in late 2010 during the American Society for Bone and Mineral Research (ASBMR) annual meeting in Toronto, Canada, as a public-private partnership (based on other successful healthcare partnership models) co-convened by ASBMR and the National Osteoporosis Foundation (NOF). Given the alignment with NOF’s mission of bringing together patients and physicians around bone health, NOF houses and manages NBHA as a founding partner tasked to move the concept forward by the National Coalition for Osteoporosis and Related Bone Disease. To support its operations, NBHA generates annual membership fees from its private and nonprofit sector participants; additional funds are raised to support specific activities and projects.
Since 2010, what started as a small group of NBHA’s founding members has grown to include 52 member organizations (35 nonprofit organizations and 17 companies) and 4 federal government agency liaisons from the Centers for Disease Control and Prevention, National Aeronautics and Space Administration, National Institutes of Health and U.S. Food and Drug Administration. Through its members and partners, NBHA has a collective reach of more than 100,000 healthcare professionals and 10 million consumers.
NBHA Members (52)
U.S. National Bone Health Alliance (NBHA) executive committee members
• Keith Hruska, MD (Co-Chair)
Professor of Pediatrics, Medicine and Cell Biology, Washington University/St. Louis Children's Hospital and Past President, American Society for Bone and Mineral Research
• Robert Recker, MD, MACP, FACE (Co-Chair)
Director, Osteoporosis Research Center, Creighton University and President, Board of Trustees, National Osteoporosis Foundation
• Robert Lindsay, MD, PhD (Promotion and Prevention Strategic Area Champion)
Chief, Internal Medicine, Helen Hayes Hospital and Professor, Clinical Medicine, Columbia University
• Ethel S. Siris, MD (Screening, Diagnosis and Treatment Strategic Area Champion)
Director, Toni Stabile Osteoporosis Center and Madeline C. Stabile Professor of Medicine, Columbia University
• Daniel H. Solomon, MD (Research, Surveillance and Evaluation Strategic Area Champion)
Associate Professor of Medicine, Harvard Medical School
NBHA’s 20/20 Vision: Reducing Bone Breaks 20 % by the Year 2020
The members of NBHA are working from a shared 20/20 vision: to reduce bone breaks 20 % by the year 2020 and to improve the overall health and quality of life of all Americans by enhancing their bone health. NBHA is also responsible for implementing the 3 other priority areas identified in the National Action Plan for Bone Health: promoting bone health and preventing disease; improving diagnosis and treatment; and enhancing research, surveillance and evaluation. NBHA is a platform that allows all voices in the bone health community to harmonize into 1 voice to deliver clear, concise messages.
The operations and major activities of NBHA are funded through financial support from its members, which may include but are not limited to corporations, academic and medical institutions, professional and membership organizations, associations, advocacy groups, and nonprofit and philanthropic organizations.
Members use their collective voice and diversified membership base to weigh-in on significant issues related to bone health, including vitamin D and calcium; bone density testing reimbursement and utilization; and the benefits and risks of the use of bone health therapies. NBHA’s platform allows for ongoing communication among individuals and organizations interested in bone health; for shared projects to become realities through pooled funding; and collaboration to achieve the goals and recommendations of the National Action Plan for Bone Health.
NBHA Projects and Working Groups
NBHA pursues projects and activities that leverage the expertise and resources of its multi-sector members. In addition to raising funds for project development and operations from its member organizations, NBHA also raises funds for each individual project or activity that requires financial resources to execute. NBHA members and other experts make up the various committees, project teams and working groups that carry out the work of the Alliance.
Secondary Fracture Prevention Initiative (2011-Present)
Providing Technical Assistance to Sites, Health Insurers, Accountable Care Organizations and Other Entities Wishing to Implement this Model of Care
Despite the proven effectiveness of the FLS model of care to decrease fractures and increase the rates of osteoporosis screening, treatment and healthcare quality [3–5, 6•] it has not been implemented broadly in the United States for a number of reasons, including lack of awareness about the FLS model of care itself, particularly among primary care practitioners and hospital administrators; lack of knowledge by healthcare administrators and healthcare professionals (as well as potential sites) about this model of care and how it can be implemented; and lack of publicly-accessible tools to help interested sites, healthcare professional champions, and healthcare administrators implement the FLS model of care.
To address this gap, NBHA launched Fracture Prevention CENTRAL in March 2013 (www.FracturePreventionCENTRAL.org), an online resource center which includes a robust, publicly-assessable toolkit to help those interested in starting a FLS program along with guidance on the financial business case to do so. In the 6 months since Fracture Prevention CENTRAL was launched, nearly 1000 individual users have signed up for access to these tools and resources.
In addition, through Fracture Prevention CENTRAL, NBHA is sponsoring a series of educational webinars (available free of charge to users and archived for on demand viewing) on the FLS model of care and will support FLS experts to highlight this model of care to healthcare professional audiences at 3 national meetings.
Implementing Pilots and Demonstration Projects
NBHA is pursuing support for pilots and demonstration projects to test methods to efficiently deploy and standardize FLS programs in the open system with government, philanthropic and private sector groups.
Exploring the Creation of Additional Reimbursement Code(s) to Support the Efforts of FLS Care Coordinators, Currently the Greatest Barrier to Widespread ImplementationNBHA has convened a FLS Reimbursement Working Group comprised of interested NBHA members to explore the current reimbursement landscape; the group’s major activities include:
Define the mechanisms for FLS coordinator reimbursement in the current system to develop a resource that can be disseminated by NBHA through Fracture Prevention CENTRAL;
Draft a white paper to take a comprehensive look at the reimbursement landscape that identifies current reimbursement practices as well as FLS coordinator reimbursement gaps; and
Pursue potential pilots to test new FLS reimbursement models.
Working with Other Secondary Fracture Prevention Efforts
NBHA works closely with other national and international efforts focused on fostering the FLS model of care and secondary fracture prevention, including the American Society for Bone and Mineral Research, International Osteoporosis Foundation Capture the Fracture campaign, Fragility Fracture Network, and International Geriatric Fracture Society.
Project: 2Million2Many Osteoporosis Awareness Campaign (2012-Present)
Another major NBHA program is the award-winning 2Million2Many (www.2Million2Many.org) national public and healthcare professional awareness campaign, designed to break through the clutter and elevate osteoporosis to an issue of national concern. The campaign draws attention to the 2 million bone breaks that occur in the U.S. every year due to osteoporosis and issues a clear and simple call to action for healthcare professionals and consumers alike: if you or a loved one age 50 or above suffers a fracture, ask your healthcare professional for a bone density test.
Bone Turnover Marker Standardization Project (2011-Present)
Although bone turnover markers have the potential to be used as an additional tool for healthcare professionals to monitor or detect possible bone loss, predict fracture risk, and measure response to therapy, shortcomings related to sample collection and analysis have minimized their clinical use. The NBHA Bone Turnover Marker Standardization Project is a multi-faceted effort focused on 1bone resorption marker (serum C-terminal telopeptide (CTX)) and 1 bone formation marker (serum total procollagen type 1 N-terminal propeptide (P1NP)) identified as most promising to be used as reference markers [8•] and measured by standardized assays. Biochemical bone turnover markers—which help healthcare professionals assess changes in bone metabolism and determine the effectiveness of treatment—have been used in clinical trials as supportive data and have been recognized as potentially useful tools in clinical practice, but variability, such as a difference in collection and analysis from laboratory to laboratory, has led to inconsistencies.
The NBHA Project Team published a position paper in Osteoporosis International (July 2012) [9••] that highlights the challenges related to the use of widespread bone turnover markers, including the variation between manufacturer assays, biological fluctuations in marker levels, and differences in laboratory performance.
Moving forward, the NBHA Project Team is executing activities including plans to achieve harmonization among manufacturer assays, consensus on standard sample collection and analysis protocols and harmonization of existing reference ranges from different manufacturers.
Rare Bone Disease Working Group (2012-Present)
NBHA’s Rare Bone Disease Working Group brings together leading patient advocates, clinical researchers, and industry to advance common interests within the heterogeneous rare bone disease community. The Working Group is planning a 1-day summit to take place in September 2014 (in conjunction with the ASBMR annual meeting in Houston, TX) focusing on advances in diagnosing rare bone disorders, gaps in understanding critical genetic pathways, and new opportunities for treatment.
Clinical Diagnosis of Osteoporosis Working Group (2012-Present)
This Working Group’s goal is to formulate a clinical basis for expanding the definition of the clinical diagnosis of osteoporosis, per the paper “What’s in a name? What constitutes the clinical diagnosis of osteoporosis?”[10••]. The Working Group has reached consensus around this issue and is preparing a paper for publication presenting the rationale and will then work to implement it into new ICD-10 coding.
The National Bone Health Alliance is a unique public-private partnership focused on preventing bone diseases. Private and nonprofit organizations are encouraged to contact NBHA to become members and join its efforts. For more information about NBHA’s projects and how to get involved, visit NBHA’s website at www.nbha.org as well as its Fracture Prevention CENTRAL (www.FracturePreventionCENTRAL.org) and 2Million2Many (www.2Million2Many.org) microsites, or contact NBHA directly at firstname.lastname@example.org.
Compliance with Ethics Guidelines
Conflict of Interest
DB Lee, MR Lowden, V Patmintra, K. Stevenson are all employed by the National Bone Heath Alliance which has received a start-up grant from Amgen and continuing support from 4 Bone Health; American Academy of Nurse Practitioners; American Academy of Physicians Assistants; American Association of Clinical Endocrinologists; American Academy of Orthopaedic Surgeons; Amgen Inc.; American Orthopaedic Association; American Society for Bone and Mineral Research; The Aspen Institute; Break4Health; California Hispanic Osteoporosis Foundation; DePuy Synthes; Eli Lilly and Company; The Endocrine Society; Fibrous Dysplasia Foundation; Foundation for Osteoporosis Research and Education/American Bone Health; GE Healthcare Lunar; Gerontological Society of America; Global Healthy Living Foundation; Health Monitor Network; HealthyWomen; Hologic, Inc.; Immunodiagnostic Systems; International Geriatric Fracture Society; International Society for Clinical Densitometry; Kaiser Permanente; Marodyne; Marian Osteoporosis Center (Santa Maria, CA); Medtronic; Merck & Co., Inc.; MindwaysCT; National Osteoporosis Foundation; Novartis Pharmaceuticals Corporation; Optasia Medical, Inc.; Osteoporosis Medical Center (Los Angeles, CA); OWL: The Voice for Midlife and Older Women; QuantiaMD; Roche Diagnostics Corporation; Sectra; Soft Bones, Inc.; United States Bone and Joint Initiative; Warner Chilcott; Washington Osteoporosis Coalition; and Women in Government.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.