It is bittersweet to be submitting my final report to you as ASBMR President. Sweet because it’s been a great year and we have really made a difference, especially with our strategic plan to address the crisis in the treatment of osteoporosis. Bitter because the year is over much too fast. We still have a lot of work to do and I look forward to working with Mike next year. I want to thank Doug for his leadership with our new culture statement, the strategic plan, the stakeholder summit on secondary fracture prevention and possibly a new governance model, just to name a few. I look forward to also working with our new President-elect, Dr. Bart Clark and our new Treasurer-elect, Dr. Juliet Compston.
We continue to maintain our high level of activity within the organization and I would like to thank all of you for your hard work and continued dedication to ASBMR. It takes our full team of volunteer leaders and staff to accomplish all that we do to further the bone, mineral and musculoskeletal field and I am honored to work alongside you in achieving these goals.
As we continue to drive our overall mission of advancing bone, mineral and musculoskeletal science worldwide, promoting the translation of basic and clinical research to improve human health together, and celebrating forty years of scientific excellence within our field, let me reflect on how we have accomplished these objectives throughout the course of 2017.
ASBMR Strategic Plan
ASBMR’s four strategic priorities of the 2015-2018 strategic plan serve as our guide through our numerous activities. Our four strategic priorities are:
- Closing the Treatment Gap, including Identification of an Improved Clinical Trial Endpoint
- Drive, Expand and Translate the Research Agenda in Musculoskeletal Science
- Increase International Outreach and Strengthen International Engagement to Create ‘One Global ASBMR Family’
- Develop New Strategies and Revenue Streams to Enable ASBMR to Invest in the Future of the Field
With the strategic plan as our roadmap, the following activities highlight our progress as it fits within the key strategic priorities.
Closing the Treatment Gap, including Identification of an Improved Clinical Trial Endpoint
Expand Communications to Members and the Public about Evidence on the Effectiveness and Safety of Treatments
Since leading the launch of the “Call to Action to Address the Crisis in the Treatment of Osteoporosis” at the 2016 Annual Meeting, ASBMR has continued to work with our stakeholder partners to promote, advocate and educate on reducing the treatment gap. Currently thirty-nine organizations from around the world have signed the Call to Action.
In February 2017, the Multi-Stakeholder Initiative was formed and began working with the Center for Medical Technology Policy (CMTP). At the same time an Experts Group was formed to advise on the initiative. The group, chaired by Sundeep Khosla, M.D. and Douglas P. Kiel, M.D., MPH, consists of the following members: Doug Bauer, M.D., Susan Bukata, M.D., Jane Cauley, DrPH, Juliet Compston, M.D., FRCP, Kristine Ensrud, M.D., MPH, Deborah Gold, Ph.D., Susan Ott, M.D., Cliff Rosen, M.D., Ken Saag, M.D., MSc, Elizabeth Shane, M.D., and Dan Solomon, M.D., MPH. Four objectives were established for the Multi-Stakeholder Initiative Meeting: 1) to bring together national and international representatives from affected stakeholder groups and facilitate open and frank discussion in order to gain a shared understanding of osteoporosis and its consequences; 2) to focus on secondary fracture prevention and foster consensus, based on this shared understanding, on the most appropriate approaches to reduce fractures in patients who have already experienced one; 3) to develop a strategy for implementing those approaches; and 4) to assess interest in continued dialog and collaboration to advance work on reducing fractures.
The invitation-only “Fracture Prevention Stakeholder Summit” was held on July 19 with approximately 60 individuals in attendance from a broad array of stakeholders. The interactive meeting featured panel presentations and breakout discussions, and included the opportunity to hear from patients with osteoporosis. A strategic roadmap for the next steps on how to address the crisis in treatment is being developed based on the consensus that was determined in the structured discussions at the Summit and will be presented at the ASBMR 2017 Annual Meeting in Denver.
At the urging of Sundeep Khosla, M.D. and Elizabeth Shane, M.D. last year, in their roles on the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Council, NIAMS is partnering with multiple other federal stakeholders (NIA, NIDDK, NCATS, NCCIH, NIDCR, and the Office on Research on Women’s Health) to engage the NIH Office of Disease Prevention (ODP). ODP, through its program, Pathway to Prevention (P2P), will provide an objective, external review of current state-of-the-science related to fracture prevention and important gaps in knowledge. Research gaps and methodological and scientific weaknesses will be identified. A research agenda will be suggested to move our field further in addressing the crisis. This will involve working with the Agency for Healthcare Research and Quality (AHRQ) to solicit proposals from Evidence-Based Practice Centers to prepare an evidence report addressing the key questions being posed, followed by a conference in 2018 similar to previous NIH Consensus Conferences. The proceedings of this effort will be published and disseminated, with a key target being primary care physicians so that they can better provide the appropriate evidence to patients.
In early May and after the FDA’s approval of TYMLOS™ (abaloparatide), the Institute for Clinical and Economic Review (ICER) released its draft evidence report, Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value. The report evaluated the economic value and effectiveness of anabolic therapy treatment in comparison with other currently established treatments and made a recommendation as to their overall value. ASBMR and NOF joined with the National Bone Health Alliance (NBHA), which we co-chair, to form an NBHA Work Group to carefully review and interact with ICER staff on the ICER report. Representatives from the ASBMR include the Chair of the Professional Practice Committee, Benjamin Leder, M.D., NBHA Co-chairs Bob Adler, M.D. and Ken Saag, M.D., and other ASBMR members. Members of the NBHA Work Group believed that ICER issued their report prematurely, since much of the research on the new anabolic therapies is not yet in the public domain and thus could not be part of the evidence evaluated. Other concerns have been raised regarding the economic modeling for cost effectiveness. ASBMR issued a statement to the media regarding the report, as did several other organizations.
Our Professional Practice Committee (PPC) prepared written comments on the report at the submission deadline of May 31st and Benjamin Leder, M.D. traveled to Los Angeles, USA at the end of June to testify on behalf of ASBMR in person at the California Technology Assessment Forum (CTAF) and present concerns with the evidence being utilized to assess the cost effectiveness of anabolic therapies. On July 17, ICER issued its final report, which was more measured than expected and included some of the points raised by Dr. Leder about the lack of evidence available to make an evidence-based assessment of the effectiveness of anabolic therapies in treatment of osteoporosis.
Just prior to the Summer Council meeting, the FDA delayed the release of Amgen’s EVENITY™ due to the imbalance of serious cardiovascular events in the active comparator trial, ARCH, which compared romosozumab with alendronate. Serious CVD events were observed at a rate of 2.5% in the romo group compared to 1.9% in the alendronate group. In the FRAME placebo-controlled study, there were no excess CVD events in the romo compared to the placebo groups. Amgen/UCB have submitted a late breaking abstract to ASBMR on these CVD events – “A Randomized Alendronate-Controlled Trial of Romosozumab: Results of the Phase 3 ARCH Study (Active-contRolled fraCture study in postmenopausal women with osteoporosis at High risk)” - and it will be presented at an oral session on Monday, September 11.
Create a Research Agenda to Close the Treatment Gap
The research agenda around closing the treatment gap on the number of patients needing treatment continues to evolve and move forward. Accomplishments and areas to highlight include:
The Professional Practice Committee (PPC) reviewed the recent American College of Physicians (ACP) update to its 2008 clinical practice guidelines for the treatment of osteoporosis. The PPC comments were used to create an ASBMR statement to the media on the issue, which applauded the ACP with this step to lead more primary care physicians to screen and treat patients to prevent fractures but pointed out key areas where the recommendations fall short. At the Annual Meeting we will have a special session on the ACP Guidelines on Saturday at 11 am with Carolyn Crandall and Benjamin Leder discussing the guidelines from the primary care physician and specialist perspectives.
ASBMR continues to provide support for the FNIH Bone Quality Project, led by PI Dennis Black, Ph.D. In April the project filed a Letter of Intent (LOI) for the qualification of total hip bone mineral density as an efficacy response biomarker and surrogate for fracture risk reduction in clinical trials. This biomarker would be used to support a claim of hip fracture reduction in a placebo-controlled clinical trial. This surrogate marker could be used only after a vertebral fracture reduction was observed in randomized clinical trials. The FNIH group received an encouraging response to their letter. Preparations are underway for the initial briefing document with a goal of submitting it later this year. In addition, the group submitted an abstract, to be presented on Monday, on the relationship between femoral strength from QCT-based finite element analysis and femoral BMD before and after treatment. The FNIH working group is developing four manuscripts describing their initial results. A manuscript on bone turnover markers as surrogates will be submitted to JBMR® soon. Dennis Black provided an overview of their progress at the recent ECTS meeting.
Drive, Translate and Expand the Research Agenda in Musculoskeletal Science
Creation of Standards and Definitions Around Significant Research Tools
To address standards for high resolution peripheral quantitative computed tomography (HR-pQCT), ASBMR representatives Mary Bouxsein, Ph.D., and Eric Orwoll, M.D. were added to the International Osteoporosis Foundation project on HR-pQCT co-chaired by Mary Bouxsein, Ph.D. The group met in March 2017 at WCO-IOF-ESCEO to continue work on a draft manuscript.
The ASBMR-ORS Task Force on Cell Based Therapies is expected to complete its report in Q3 of 2017. To follow up on that report, ECTS has proposed a new joint task force on Mesenchymal Stem Cells (MSC) Standardization. This proposal will be further discussed and charges will be established to guide the direction of this project.
Advance Knowledge on Functional Genomics
For the 2016 meeting, the Program Committee agreed that too much of the Annual Meeting has become a passive process of receiving vast amounts of information with only limited opportunities to interact with our acclaimed speakers. They introduced a set of “Hands-On Workshops” each day at 11:00 AM that engaged members. This was quite popular last year and the 2017 Program Committee elected to continue these Hands-On Workshops. We decided to continue the more popular Hands-On Workshops including workshops on Biomechanical Phenotyping, Histomorphometry and RNA Sequencing Computational Analysis Training. For the 2017 meeting we have added 2 new Hands-On Workshops: Functional In Silico Assessment of Genomic Regions Influencing BMD and Skeletal Muscle Biology and Function. We welcome your feedback on these Hands-On Workshops and suggestions for other Hands-On Workshops in future meetings.
The Launch of JBMR® Plus
JBMR® Plus successfully opened for submissions in January and published five articles in the first quarter. Five review articles from prominent ASBMR members have also been commissioned and these are due to be submitted over the next 2 months. Nearly 25% of authors who have been offered a transfer to JBMR® Plus have accepted this transfer, a very good referral rate for a new cascade journal. The first official edition of the publication will be released at the end of August 2017. We are also looking forward to a reception to celebrate the successful launch of JBMR® Plus at the Annual Meeting. I would like to thank Editor-in-Chief Peter Ebeling, AO, M.D. and Deputy Editors Teresita Bellido, Ph.D. and Bo Abrahamsen, M.D., Ph.D. for all their hard work in the launching of JBMR® Plus this year and look forward to their continued efforts as JBMR® Plus to help publish the best research in the bone, mineral and musculoskeletal field. We have also added 4 new associate editors: Fanxin Long, Ph.D., Washington University School of Medicine, USA; Luigi Gennari, M.D., Ph.D., University of Siena, Italy; Suzanne Marie Jan De Beur, M.D., Johns Hopkins University, USA; Xiang-hang Luo, Xiangya Hospital of Central South University, China.
The Ninth Edition of the ASBMR Primer
The manuscripts are all in for the 9th Edition of the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. The Section Editors, Senior Associate Editors, and Editor-in-Chief John Bilezikian have our thanks for the tireless acquisition, peer review, and finalization of 135 new and updated chapters for this edition. While print copies of the new Primer will not be ready in time for the Annual Meeting, Wiley staff will be previewing chapters and multimedia features on the companion website, as well as taking customer inquiries and preorders onsite in the ASBMR Networking Center.
Increasing JBMR® Visibility
The Editors-in-Chief and ASBMR staff met at Wiley headquarters in April to set JBMR® strategy for the year ahead. The coming months will focus on campaigns to show appreciation for reviewers and highlight the extraordinary work they do for the journal, increase content visibility in China and Japan through cross-community campaigns and newsletters, grow usage globally by 5%, and increase submissions by 3% in repeat authors and international early career researchers. These campaigns are designed to fortify JBMR’s position in its peer group in preparation for the Editor transition at the end of this year, when Editor-in-Chief Juliet Compston, M.D. steps down at the end of her 5-year term at the end of December and Roberto Civitelli, M.D. becomes the new Editor-in-Chief. Thank you, Juliet, for spearheading many new directions for our journal.
Increase International Outreach and Strengthen International Engagement to Create ‘One Global ASBMR Family’
ASBMR International Outreach and Engagement
The Membership Engagement and Education Committee, chaired by Nicola Napoli, M.D., has worked with staff throughout the year to develop and implement the recommendations presented at the Winter and Summer Council Meetings. An extensive survey of the current membership, along with recently lapsed members, was conducted in Spring 2017. The results revealed to us that the primary reasons we are seeing a drop in membership is the lack of funding being felt at all career levels and non-attendance at the ASBMR Annual Meeting due to high travel costs.
Upon recommendation from MEEC, the Executive Committee approved the piloting of several new travel grant initiatives in 2017 aimed toward increasing engagement:
- Modified the amount of funding for young investigator travel grants to increase the amount for international recipients to $750 USD and maintain the amount for North Americans at $500 USD. Previously $500 USD was awarded to all recipients, regardless of geography.
- Created twenty new travel grants for Mid-Career Faculty Investigators in the amount of $500 USD for North American recipients and $750 USD for international applicants.
- Created five new travel grants for Research Teams geared toward mid-career and senior investigators plus one individual from their team to attend the meeting. These grants range from $1,000 USD for North American recipients and $1,500 for international applicants.
- Created new Diversity and Emerging Country travel grants ($500 for top-scoring abstract by a self-identified under-represented minority young investigator and $750 for top-scoring abstract by a young investigator from an emerging country).
We have been actively increasing our participation in a number of international meetings. In March 2017 we reprised the joint ASBMR/IOF session from our 2016 Annual Meeting on “Fracture risk assessment to target treatment: Effectiveness and cost-utility” at the WCO-IOF-ESCEO meeting in Florence, Italy with Bo Abrahamsen, M.D., Ph.D. serving as the ASBMR Co-Chair for the session along with John Kanis, M.D. as the IOF Co-Chair. A session on “Reducing the Treatment Gap,” jointly moderated by myself and Cyrus Cooper, the new IOF President, at this year’s Annual Meeting in Denver will continue this partnership.
In May 2017 Steve Harris, M.D. and I participated in the ECTS 2017 ECTS/ASBMR Clinical Debate, “This house believes that anabolic therapy should be first line therapy for all patients with established osteoporosis,” as presenter and co-chair, respectively. Bente Langdahl, M.D. and Claus C. Glüer, Ph.D. were the ECTS presenter and co-chair representatives. Bente was for the motion and Steve was against the motion. Both presenters did an outstanding job and Steve Harris made ASBMR proud. However, the trend is to be more aggressive with anabolic therapy despite the cost implications and the “Golden Femur Award” went to ECTS. Our Annual Meeting also features a Clinical Debate with ECTS, entitled, “Anti-Resorptive Therapy during the menopausal transition prevents bone fractures later in life” with Dolores Shoback, M.D. (ASBMR) and Richard Eastell, M.D. (ECTS) as co-chairs and Gail Greendale, M.D. (ASBMR) (against the motion) and Erik Eriksen, M.D. (ECTS) (for the motion) as the presenters. We will continue this successful partnership of Clinical Debates at ECTS 2018.
In June 2017 Carolyn Crandall, M.D. and Charles Farber, Ph.D. represented ASBMR at the ANZBMS-IFMRS-JSBMR meeting in Brisbane, Australia, making presentations on “Screening for osteoporosis and fracture risk: a primary care perspective” and “Systems approaches to investigate the molecular basis of bone strength.” In August 2017 we participated in a joint symposium with the Fragility Fracture Network at their FFN Global Congress in Sweden. Nicola Napoli, M.D., and Bente Langdahl, M.D., DMSc represented ASBMR at the session on “Under-Treatment of Patients at Risk of Fractures.” In October 2017 we will participate in a joint session on osteo-anabolic therapies with SIOMMM at their 2017 Meeting, with John Bilezikian, M.D., Nicola Napoli, M.D., and myself representing ASBMR. The current plan is for me to discuss identifying the high risk patient and John and Nicola, anabolic therapies. John Bilezikian, M.D., and Cliff Rosen, M.D. will represent ASBMR at the 2017 ABRASSO meeting in Brazil, presenting a session on the 2017 Annual Meeting Highlights, and Teresita Bellido, Ph.D. will do the same at the 2017 AAOMM meeting in Argentina.
International Federation of Musculoskeletal Research Societies (IFMRS)
The International Bone and Mineral Society (IBMS) is in the process of completing its dissolution and the transfer of its assets to IFMRS. The IFMRS Board of Directors held a strategic planning retreat in Boston earlier this year. IFMRS also partnered with ANZBMS this year on a joint meeting in Brisbane, Australia in June 2017. IFMRS will continue to expand the Big Data Initiative and collaborate with other societies on educational programs and exchange grants. Initiatives in the planning stage include the development of research and travel grants and a Future Global Leaders Committee for early career investigators. Five ASBMR members have expressed an interest in being appointed to be ASBMR’s representative on this committee and one will be selected by the Executive Committee.
Develop New Strategies and Revenue Streams to Enable ASBMR to Invest in the Future of the Field
ASBMR Fund for Research and Education
The ASBMR Development Committee, co-chaired by Bart Clarke, M.D. and Shonni Silverberg, M.D., has worked hard over the last year to develop an individual giving campaign for the ASBMR Fund for Research and Education. In acknowledgement of the 40th Anniversary of ASBMR, the Fund launched a “$40 for 40” campaign in 2017, encouraging members to donate $40 (or more!) in support of the Society. Of course we can always accept larger donations!
We are pleased to announce that as a result of donations to the Fund, a new Research Grant Program has been created to provide funding in the amount of $7,500 USD to promising young scientists and physician-scientists in the bone field who are currently seeking to learn a new technique or to obtain additional funding to successfully complete a project. 27 applications across basic, clinical, and translational were received and two awards will be given in 2017. The Development Committee reviewed the applications and the awardees will be announced prior to the meeting:
- Basic/Translational: Jessica Alm, Ph.D., Karolinska Institutet, Research Team on Metabolic Bone Diseases, Department of Clinical Genetics, Center of Molecular Medicine and Surgery, Sweden; Cellular manifestation of gene defects leading to osteoporosis – Functional characterization of the skeletal cell compartment
- Clinical: Christina Vrahnas, Ph.D., St.Vincent's Institute of Medical Research, Australia; high throughput methods for quantitative backscattered electron scanning microscopy (qBSEM) and Faxitron digital x-ray micro radiographic analysis to examine mineral distribution in bone
The 2017 recipients of the ASBMR Fund for Research and Education Young Investigator Awards, who will receive $1,500, are:
- Jasna Aleksova, Ph.D., Endocrinology Fellow, Monash Health in Australia
- Thomas Funck-Brentano, M.D., Ph.D., Post-doctoral fellow at the Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenberg in Sweden
We also are pleased to continue the Betsy Love McClung MN, RN Travel Grant program for Allied Health Professionals to attend the ASBMR 2017 Annual Meeting. Five applications were received and two awards of $1,500 will be given to the top-scoring candidates:
- Amy Mundy, F.N.P., Endocrine Nurse Practitioner at McGuire VA Medical Center in Richmond, VA, USA
- Pauline Fisher, R.N., Clinical Nurse Specialist at Hamilton Health Sciences, Ontario, Canada.
ASBMR Rising Star Award
The ASBMR Rising Star Award Committee has concluded the 2017 program and is pleased to announce the following six recipients of the Rising Star Award:
- Brya Matthews, Ph.D., University of Auckland, “Novel Osteoprogenitor Cell Populations Involved in Bone Healing” (Sir Charles Hercus Health Research Fellowship, New Zealand)
- David Scott, Ph.D., Monash University, “Reducing Risk Factors for Falls and Fracture in Obese Older Australians” (Career Development Fellowship (R.D. Wright Biomedical CDF Level 1), Australia)
- Saravana Ramasamy, Ph.D., Imperial College London, ”Aetiology and consequences of vascular ageing in the skeletal system” (Sir Henry Dale Fellowship, United Kingdom)
- Marc Wein, M.D., Ph.D., Massachusetts General Hospital, “Dissecting the roles of class IIa HDACs in osteocyte biology” (K08 grant, U.S.A.)
- Kathleen Hill-Gallant, Ph.D., Purdue University, “Phosphorus Absorption and Balance in Normal Physiology and Chronic Kidney Disease” (K01 grant, U.S.A.)
- Jonathan Mitchell, Ph.D., Children's Hospital of Philadelphia, “Sleep, Energetic Behaviors, and Adolescent Obesity during the Transition from Middle to High School” (K01 grant, U.S.A.)
The award provides funding to our most promising young scientists and physician-scientists in the bone field who have already been recognized by NIH “K awards” and other similar international career development programs. The award provides $60,000 USD in funding for each awardee – three US-based and three international – to help them successfully implement their programs, stay in the field and transition to become independent investigators. Many thanks go to our program chairs, Teresita Bellido, Ph.D. and Richard Eastell, M.D., and the entire Rising Star Review Committee for all their work in reviewing the applications and determining the winners.
ASBMR 2017 Annual Meeting
The ASBMR Annual Meeting is the highlight of each year. I have truly enjoyed working with my basic, translational and clinical co-chair colleagues Anna Teti, Ph.D., Teresita Bellido, Ph.D. and Kenneth Saag, M.D. and ASBMR staff to develop the scientific program for this year’s meeting in Denver. Some highlights of the program include:
- Gerald D. Aurbach Lecture on “Cellular Senescence: Yin and Yang”, Judith Campisi, Ph.D.
- Louis V. Avioli Lecture on “The Quest for Osteoporosis Mechanisms: How Far We’ve Come, How Much Further We Need to Go”, Stavros Manolagas, M.D., Ph.D., University of Arkansas for Medical Sciences (USA)
- Two Clinical Evening Sessions: “Treating the Treatment Gap” and “Management and Treatment of Rare Bone Diseases”
- Basic Evening: “The Bone Marrow Niche and Hematopoiesis”
- ASBMR/ECTS Clinical Debate: “Anti-Resorptive Therapy During the Menopausal Transition Prevents Bone Fractures Later in Life”
- ASBMR-IOF Session: “Reducing the Treatment Gap”
- 40th Anniversary Plenary Symposium: Paula Stern, Ph.D., Steve Cummings, M.D. and Jack Martin, A.O., M.D., D.S.C., F.R.A.C.P, F.R.C.P.A., F.A.A., F.R.
- A variety of symposia on CRISPR, Sleep, Energy Metabolism and Musculoskeletal disease, Testosterone Treatment, Bone Muscle Interactions, and Rare Bone Diseases are planned.
In addition to the Annual Meeting, we will again host a pre-meeting symposium, ASBMR Symposium – Current Concepts in Bone Fragility: From Cells to Surrogates, organized by Mary Bouxsein, Ph.D., Claus Glüer, Ph.D. and Marjolein van der Meulen, Ph.D. Highlights of the program include:
- Hierarchical Materials in Nature: How Bone is Tough
- Interaction of Skeletal Traits Determines Long Bone Fragility
- Tissue-to-Material Level Contributions to Bone Mechanical Behavior
- Contribution of Bone Microstructure to Bone Mechanical Behavior
- Translation of Bone Strength Assessments to Clinical Utility
- Surrogate Endpoints for Clinical Outcomes in Osteoporosis
It has been my distinct pleasure to work with all of you throughout this year in serving our membership and continuing to advance bone, mineral and musculoskeletal science worldwide and to promote the translation of basic and clinical research to improve human health. Thank you again to all of you for all the efforts you pour into our organization to make it the Premier Society for bone, mineral and musculoskeletal science. Its ben a privilege to serve as your President and a highlight of my career. Thank you again for giving me this opportunity.
Jane A. Cauley, DrPH