Report Title:

Osteoporosis Prevention


Establishes an osteoporosis prevention and treatment education program within the department of health. Establishes interagency council on osteoporosis. Appropriates funds to DOH.


S.B. NO.









relating to osteoporosis.



SECTION 1. The legislature finds that as the "Health State", Hawaii has a responsibility to educate its citizens in good health habits and prevention of disease. As our population ages, medical conditions can increase the burden placed upon health funding and other medical and social services. Osteoporosis, a bone-thinning disease, can affect both sexes and contribute to hospitalization and disability. Education about proper diet, exercise, and mineral supplementation can help to prevent the increase of incidence of this disease. The purpose of this Act is to promote a multi-pronged educational effort for all ages through as many contact points as possible, including the schools, medical community, and public services agencies. Training, screening and referral efforts, educational materials, funding, and other programs to heighten awareness of this disease are important to reduce the incidence of this silent, devastating disease.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:


321-A Definitions. As used in this part, unless the context clearly requires otherwise:

"Council" means the interagency council on osteoporosis established by this part.

"Department" means the department of health.

"Program" means the osteoporosis prevention and treatment education program established by this part.

321-B Findings and purposes. (a) The legislature finds the following:

(1) Osteoporosis, a bone-thinning disease, is a major public health problem that poses a threat to the health and quality of life to as many as twenty-eight million Americans;

(2) The one and one-half million fractures each year that result from osteoporosis cause pain, disability, immobility, and social isolation, affecting quality of life and threatening people's ability to live independently;

(3) Because osteoporosis progresses silently and without sensation over many years, and many cases remain undiagnosed, its first symptom is often a fracture, typically of the hip, spine, or wrist;

(4) One of two women and one of eight men will suffer an osteoporotic fracture in their lifetime;

(5) A woman's risk of hip fracture is equal to her combined risk of breast, uterine, and ovarian cancer;

(6) The annual medical costs of osteoporosis to the health care system are estimated to be nearly $13,800,000,000, and are expected to rise to between $60,000,000,000 to $80,000,000,000 by the year 2020;

(7) Since osteoporosis progresses silently and currently has no cure, prevention, early diagnosis, and treatment are key to reducing the prevalence of and devastation from this disease;

(8) Although there exists a large quantity of public information about osteoporosis, it remains inadequately disseminated and is not tailored to meet the needs of specific population groups;

(9) Most people, including physicians, health care providers, and those in government agencies, continue to lack knowledge in the prevention, detection, and treatment of the disease;

(10) Experts in the field of osteoporosis believe that with greater awareness among medical experts, service providers, and the public, osteoporosis can be prevented in the future, thereby reducing the costs of long-term care;

(11) Osteoporosis is a multi-generational issue because building strong bones during youth and preserving them during adulthood may prevent fractures in later life; and

(12) Educating the public and health care community throughout the State about this potentially devastating disease is of paramount importance and is in every respect in the public interest and to the benefit of all residents of the State of Hawaii.

(b) The purposes of this part are to:

(1) Create and foster a multi-generational, statewide program to promote public awareness and knowledge about the causes of osteoporosis, personal risk factors, the value of prevention and early detection, and the options available for treatment;

(2) Facilitate and enhance knowledge and understanding of osteoporosis by disseminating educational materials, information about research results, services, and strategies for prevention and treatment to patients, health professionals, and the public;

(3) Utilize educational and training resources and services that have been developed by organizations with appropriate expertise and knowledge of osteoporosis and to use available technical assistance;

(4) Evaluate existing osteoporosis services in the community and assess the need for improving the quality and accessibility of community-based services;

(5) Provide easy access to clear, complete, and accurate osteoporosis information and referral services;

(6) Educate and train service providers, health professionals, and physicians;

(7) Heighten awareness about the prevention, detection, and treatment of osteoporosis among state and county health and human service officials, health educators, and policy makers;

(8) Coordinate state programs and services to address the issue of osteoporosis;

(9) Promote the development of support groups for osteoporosis patients and their families and caregivers;

(10) Adequately fund these programs; and

(11) Provide lasting improvements in the delivery of osteoporosis health care, thus providing patients with an improved quality of life and society with the containment of health care costs.

321-C Osteoporosis prevention and treatment education program. The department of health, in cooperation with the department of education and the executive office on aging, shall establish, promote, and maintain an osteoporosis prevention and treatment education program in order to raise public awareness, educate consumers, educate and train health professionals, teachers, and human service providers, and achieve other related purposes.

321-D Program implementation. The department shall:

(1) Provide sufficient staff to implement the program;

(2) Provide appropriate training for staff of the program;

(3) Identify the appropriate entities to carry out the program;

(4) Base the program on the most up-to-date scientific information and findings;

(5) Work to improve the capacity of community-based services available to osteoporosis patients;

(6) Work with the department of education, the executive office on aging, and other governmental offices, community and business leaders, community organizations, health care and human service providers, and national osteoporosis organizations to coordinate efforts and maximize state resources in the areas of prevention, education, and treatment of osteoporosis; and

(7) Identify and, when appropriate, replicate or use successful osteoporosis programs and procure related materials and services from organizations with appropriate expertise and knowledge of osteoporosis.

321-E Public awareness. The department shall use, but is not limited to, the following strategies for raising public awareness on the causes and nature of osteoporosis, personal risk factors, value of prevention and early detection, and options for diagnosing and treating the disease:

(1) An outreach campaign utilizing print, radio, and television public service announcements, advertisements, posters, and other materials;

(2) Community forums;

(3) Health information and risk factor assessment and public events;

(4) Targeting at-risk populations;

(5) Providing reliable information to policy makers; and

(6) Distributing information through county health departments, schools, the executive office on aging, area agencies on aging, employer wellness programs, physicians, hospitals and health maintenance organizations, women's groups, nonprofit organizations, community-based organizations, and departmental regional offices.

321-F Consumer education. The department shall use, but is not limited to, the following strategies for educating consumers about risk factors, diet and exercise, diagnostic procedures and their indications for use, risks and benefits of drug therapies currently approved by the United States Food and Drug Administration, environmental safety and injury prevention, and the availability of diagnostic, treatment, and rehabilitation services:

(1) Identify and obtain educational materials, including brochures and videotapes, that translate accurately the latest scientific information on osteoporosis in easy-to-understand terms;

(2) Build a statewide capacity to provide information and referral on all aspects of osteoporosis, including educational materials and counseling;

(3) Establish state linkage with an existing toll-free hotline for consumers;

(4) Facilitate the development and maintenance of osteoporosis support groups; and

(5) Conduct workshops and seminars for lay audiences.

321-G Professional education. The department shall use, but is not limited to, the following strategies for educating physicians and health professionals and training community service providers on the most up-to-date, accurate scientific and medical information on osteoporosis prevention, diagnosis, and treatment, therapeutic decision-making, including guidelines for detecting and treating the disease in special populations, risks and benefits of medications, and research advances:

(1) Identify and obtain education materials for the professional that translates the latest scientific and medical information into clinical applications;

(2) Raise awareness among physicians and health and human services professionals as to the importance of osteoporosis prevention, early detection, treatment, and rehabilitation;

(3) Identify and use available curricula for training health and human service providers and community leaders on osteoporosis prevention, detection, and treatment;

(4) Provide workshops and seminars for in-depth professional development in the field of the care and management of the patient with osteoporosis; and

(5) Conduct a statewide conference on osteoporosis at appropriate intervals.

321-H Needs assessment. (a) The department shall conduct a needs assessment to identify:

(1) Research being conducted within the State;

(2) Available technical assistance and educational materials and programs nationwide;

(3) The level of public and professional awareness about osteoporosis;

(4) The needs of osteoporosis patients, their families, and caregivers;

(5) Needs of health care providers, including physicians, nurses, managed care organizations, and other health care providers;

(6) The services available to the osteoporosis patient;

(7) Existence of osteoporosis treatment programs;

(8) Existence of osteoporosis support groups;

(9) Existence of rehabilitation services; and

(10) Number and location of bone density testing equipment.

(b) Based on the needs assessment, the department shall develop and maintain a list of osteoporosis-related services and osteoporosis health care providers with specialization in services to prevent, diagnose, and treat osteoporosis. This list shall be made available to interested parties disseminated pursuant to rules adopted by the department, pursuant to chapter 91, with a description of diagnostic testing procedures, appropriate indications for their use, drug therapies currently approved by the United States Food and Drug Administration, and a cautionary statement about the current status of osteoporosis research, prevention, and treatment. The statement also shall indicate that the department does not license, certify, or in any way approve osteoporosis programs or centers in the State.

321-I Interagency council on osteoporosis. (a) The department shall establish an interagency council on osteoporosis. The director of health shall chair the council. The council shall be composed of representatives from the department of education, the executive office on aging, and other appropriate public and private entities with expertise in such areas as aging, health care reform implementation, education, public welfare, and women's programs.

(b) The council shall:

(1) Coordinate osteoporosis programs conducted by or through the department;

(2) Establish a mechanism for sharing information on osteoporosis among all officials and employees involved in carrying out osteoporosis-related programs;

(3) Review and coordinate the most promising areas of education, prevention, and treatment concerning osteoporosis;

(4) Assist the department and other offices in developing and coordinating plans for education and health promotion on osteoporosis;

(5) Establish mechanisms to use the results of research concerning osteoporosis in the development of relevant policies and programs; and

(6) Prepare a report that describes educational initiatives on osteoporosis sponsored by the State and makes recommendations for new educational initiatives on osteoporosis, and transmit the report to the legislature and make the report available to the public.

(c) The interagency council on osteoporosis shall establish and coordinate an advisory panel on osteoporosis, which shall provide nongovernmental input regarding the osteoporosis prevention and treatment education program. Membership shall include, but is not limited to, persons with osteoporosis, women's health organizations, public health educators, osteoporosis experts, providers of osteoporosis health care, persons knowledgeable in health promotion and education, and representatives of national osteoporosis organizations or their state or regional affiliates.

321-J Technical assistance. (a) Notwithstanding any law to the contrary, the department may replicate and use successful osteoporosis programs and enter into contracts and purchase materials or services from private organizations with appropriate expertise and knowledge of osteoporosis for such services and materials as, but not limited to, the following:

(1) Educational information and materials on the causes, prevention, detection, treatment, and management of osteoporosis;

(2) Training of staff;

(3) Physicians and health care professional education and training, and clinical conferences;

(4) Conference organization and staffing;

(5) Regional office development and staffing;

(6) Nominations for advisory panels;

(7) Support group development;

(8) Consultation;

(9) Resource library facilities;

(10) Training home health aides and nursing home personnel; and

(11) Training teachers.

(b) The department may enter into agreements to work with national organizations with expertise in osteoporosis to establish and staff offices of those organizations in the State to implement parts of the osteoporosis program.

(c) This section shall not supersede collective bargaining agreements, civil service laws, or any other laws protecting employee rights, nor shall any employee be adversely affected by this section.

321-K Contributions. The department may accept grants, services, and property from the federal government, foundations, organizations, medical schools, and other entities as may be available for the purposes of fulfilling the obligations of this program.

321-L Waivers. The department shall seek any federal waiver or waivers that may be necessary to maximize funds from the federal government to implement this program.

321-M Rules. The department of health, with the assistance of the department of education and the executive office on aging, shall adopt rules pursuant to chapter 91 as may be necessary to implement this part."

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $          , or so much thereof as may be necessary for fiscal year 2003-2004, and the same sum, or so much thereof as may be necessary for fiscal year 2004-2005, for the establishment of an osteoporosis prevention and treatment education program within the department of health as provided in this Act. The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. In codifying the new part added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in the new sections designated in this Act.

SECTION 5. This Act shall take effect upon its approval; provided that section 3 of this Act shall take effect on July 1, 2003.