FORE, Research Foundation
While American Bone Health is centered around community education - providing education, resources, and tools to help individuals and families understand bone disease and bone health, the Foundation for Osteoporosis Research and Education (FORE) is conducting community-based research to help improve the quality of care and management of osteoporosis and information to professional health care providers.
As a non-profit research center, FORE has been dedicated to preventing osteoporosis through since 1990.
In addition to providing continuing medical education, certification programs for individuals who wish to obtain their California limited license in bone densitometry and bone density testing services for low income individuals in the Bay Area, FORE has tackled problems facing osteoporosis prevention and education through many projects over the years.
Some of FORE's most significant projects
2008 - ¿Pueden Eschucharme Ahora?
FORE is taking the lead on a project to more deeply understand the perceptions, attitudes and behaviors of Latinas concerning osteoporosis, fractures and bone health and to develop educational tools, methods and delivery strategies that will effectively motivate Latinas to take appropriate prevention steps. Hip fractures have doubled among California Latinas since 1983, while remaining unchanged or declining in other ethnic groups (Zigmond, 2004).
Despite prevention efforts, Latinas as a group do not take recommended actions to protect themselves from bone loss, osteoporosis and fractures. Creating effective osteoporosis disease management in the Latino population will require coordination within the health system. The project’s Theory of Change.
To address this health system challenge, FORE convened a number of partners to design an effective community-based intervention that supports improved identification, prevention and treatment of osteoporosis for Latinos. The outcomes of this planning process are to 1) understand how to enhance preventive bone health messages for Latinas; 2) develop and test culturally and linguistically appropriate tools and strategies for the messages; and, 3) create an effective intervention plan to support osteoporosis management among Latinas and an evaluation plan to measure success. The partners all have unique strengths to contribute to a successful planning outcome and include La Clínica de la Raza, a regional Latino health care provider, the UC Berkeley School of Public Health, the California Hispanic Osteoporosis Foundation and Procter & Gamble Pharmaceuticals.
This project is supported with a grant from the John Muir/Mt. Diablo Community Health Fund.
2008 - Bone Quality Study in Oakland, California
In 2007 and 2008, we recruited over 300 women age 50-90 who had a fracture of the wrist hip or vertebrae in the last three years and were not on any bone building drugs. The data from this study will initiate a process that may provide “a bone quality” assessment to the bone diagnostics in the future.
In September 2006, FORE sponsored a colloquium on bone health in young female athletes. The colloquium focused on building an action agenda for reaching young athletes aged 10-18 based on 1) the scientific knowledge that energy deficit leads to amenorrhea and therefore bone loss and 2) that university-based programs have been successful in raising awareness among college-aged female athletes.
The participants named the syndrome Athletic Energy Deficit (AED) highlighting the crucial role nutrition plays both in peak performance and the long term bone health of female athletes. The AED Prevention Project stemmed from the colloquium and targets young female athletes and active girls ages 10 to 18. The project encourages a generation of young female athletes to be strong, healthy and competitive for a lifetime. It aims to improve bone acquisition through bone healthy nutrition and reduce complications that result from athletic energy deficit syndrome.
The colloquium scientists emphasized that there is much to learn about the causes and long-term effects of AED. However, the colloquium’s findings and plan offer a promising way to promote optimal bone growth and development among young female athletes and active girls to prevent AED in the first place.
With the support of Nike, Inc, FORE published and disseminated a guide called Compromising the Competitive Edge: Athletic Energy Deficit (AED) Impacts Bone Health in American Track & Field Magazine and Coaching Athletics. Currently 60,000 copies are in circulation and FORE has begun an Ambassador Program to educate middle and high school coaches about the syndrome.
In July 2006, FORE published the interim results of a community-based osteoporosis education and screening intervention to improve bone health for older adults.
According to three-year data from a five-year initiative in Contra Costa County, the project reached nearly 4,500 older adults from a variety of ethnic groups with bone health information and screened nearly 3,000. Sixty percent of those screened had low bone mass (osteopenia) or osteoporosis. Individuals at the highest risk for fracture were offered free calcium and vitamin D supplements and follow-up counseling for one year. Individuals identified with osteoporosis were encouraged to and assisted in seeking appropriate treatment.
The project utilized many lessons from FORE’s previously successful community-based disease management interventions to gain acceptance and reduce barriers for under-served, ethnically diverse older adults. Working with a network of referral agencies and well established organizations in the communities opened doors and built trust among community members. The agencies helped identify older adults to participate and provided sites for the screening and education programs. The program was conducted where seniors congregate and in their own languages. Over 60 different venues were used during the first three years to reach out to older adults in isolated communities. Senior centers, senior residential facilities and HUD housing projects provided excellent venues to reach older adults in settings comfortable for them.
The resulting policy brief makes the case for improving identification of low bone mass and osteoporosis among older adults by supporting community-based education and screening thus reducing the risk of life altering fractures. It explores the escalating need for osteoporosis interventions; outlines the rationale and efficacy for osteoporosis screening; presents a community-based model for screening at-risk and underserved individuals and groups; and recommends support for and improvement of community-based efforts to reach underserved, at-risk groups.
In 2003, FORE participated in the strategic planning process that engaged stakeholders in developing an action plan, A Promise of Lifelong Bone Health to address osteoporosis in California. As a member of the steering committee, FORE provided organizational support for the planning process. The resulting 10-year plan (2005-2015) is designed as a tool for collaboration, advocacy, resource development, and action to promote bone health among Californians of all ages. The California Department of Health Services, California Osteoporosis Prevention and Education program (established in 1999 by AB 161 - Alquist with FORE’s support) was the convener. The strategic results and goals continue to be relevant today. California’s Action Plan to Prevent Osteoporosis
2005 - Faces of Osteoporosis
In partnership with The California Department of Health Services, California Osteoporosis Prevention and Education program, FORE assisted in the development of the book Faces of Osteoporosis, a photo-essay compilation, reflecting the diversity of osteoporosis in California. FORE recruited participants from around the state to tell their stories showing that osteoporosis affects men, women and even children. This book smashes the stereotype that osteoporosis is a disease of older women showing that the disease has a myriad of faces, not just one. The book received a Silver Award for Excellence in Public Health Communication at the 2006 National Public Health Information Coalition annual meeting.
The Surgeon General’s report referencing the health care crisis arising out of the growing number of older adults in the United States who will fracture if steps are not taken to avoid this issue prompted the US Administration to fund this project. FORE gathered stakeholders from around the United States to put together an awareness plan that would reach women over age 65, with an emphasis on limited English-speaking and under-served women.