osteoporosis awareness-nbha- wclarke-052013

NBHA: Osteoporosis Awareness Campaign

1

National Bone Health Alliance

May 16, 2013

Osteoporosis Awareness and DXA Testing

William M. Clarke, Hologic, Inc.


2

Overview: Osteoporosis Awareness and DXA Testing Initiatives

The stark reality of osteoporosis, along with its crippling effects on the human body, somehow

fails to excite the medical community or strike fear within the souls of the masses. People, in

general, along with many primary care physicians, fail to realize the enormity and impending

threat of this disease. They are oblivious to the simplistic signs and symptoms that can ultimately

link this disease to nearly anyone who is beyond midlife in age, those over fifty who have

suffered a fracture, and even people younger in age who’s bone mass is dwindling away due to

drug-induced osteoporosis. Osteoporosis, fittingly enough, is referred to as the silent killer,

stealing your freedom, vanquishing your mobility and eventually, ending your life.

Perception is everything. When someone mentions cancer, suddenly there is muddled silence,

uneasy feelings and an ever-present fear. When a reference is made to osteoporosis, there is an

indecisive, “what is that”? An incredulous ignorance of this disease permeates society and the

devastating effects it bestows upon the body. This is another great example of what you don’t

know, will most likely kill you. Surprisingly enough, more people will die from osteoporosis this

year than both breast and prostate cancer combined.

Although more than 10 million Americans are stricken with osteoporosis, there are nearly 35

million others who have low bone mass (osteopenia) which is a precursor to developing the

disease. Physicians agree that osteoporosis is not only under diagnosed but also under treated.

Those who are at risk fail to get referred for a 15-second DXA test. Simple DXA testing can

establish the risk potential before the fracture ever occurs, yet only about 32% of those who could

be tested are currently receiving DXA exams. In many instances, even after the patient suffers a

low impact fracture (non-traumatic) which is a clear indicator of the disease, the patient still goes

untested (Boyd, 2011). DXA is a diagnostic exam (low dose x-ray) utilized to diagnose


3

osteoporosis; the hip and spine are the critical areas assessed. Once the data is acquired from the

patient, the information regarding bone density is expressed in statistical scores, T-scores and Z-

scores, which place patients in specific classifications indicated as normal, osteopenia, and

osteoporotic.

Factors Influencing the Issue

Osteoporosis appears to be surrounded by a shroud of ignorance and lack of education, for both

patients and their physicians. The general population must become empowered with regard to

bone health, and they must be educated on the risks that are involved with osteoporosis. While

physicians need to be well aware of the symptoms and risk factors involved with the disease, they

must be aggressive and test patients before the fracture occurs which will allow for expedited

treatment planning and improved patient outcomes.

DXA bone density testing is covered by both private payers and Medicare, with the average

reimbursement of about $60 (CMS, 2013) nationally. Only five years ago, reimbursement was

averaging about $150 per scan and physicians were more willing to offer DXA in their office. As

reimbursement dissipated drastically, physicians have become less likely to purchase the

Hologic DXA system 2013, standard bone density assessment package.


4

equipment, so in turn there is a lack of access for patients. Testing will usually be permitted by

CMS every other year, unless the patient is on Bisphosphonate therapy. Bisphosphonates are the

class of drugs that rebuild and fortify bones (Fosamax, Boniva, Actonel, and Reclast) and prevent

further bone loss. While being treated with Bisphosphonates, patients are allowed more frequent

DXA exams enabling clinicians to track the drug’s effectiveness.

Ultimately, ignorance and a lack of urgency have pushed osteoporosis to the bottom of the list

with regard healthcare priority. Medical professionals continue to look the other way, fail to

educate, improperly diagnose, or establish guidelines that will improve testing practices. In

retrospect, it is the patient that suffers and does not receive the appropriate DXA testing when it

should be indicated. Although patients can request the exam, it must be ordered by a physician.

When these patients move through the system untested, they eventually succumb to fractures,

unnecessary pain, and a life amassed in debilitation.

DXA exam of the hip and spine.


5

Goals and Objectives of the Campaign:

Goal: Increase the number of adults receiving DXA testing for osteoporosis evaluation.

S.M.A.R.T Objective: Within 5 years, by the end of 2018, increase the number of adults by

50%, 40 years of age or older, who are tested and evaluated with DXA bone density systems.

Target Audience

Our target audience is men and women age 40 and older, Caucasian, fair skinned and very likely

of European, Hispanic, or Asian descent. These specific cultural and ethnic groups are highly

susceptible to osteoporosis. They speak English, Spanish, and Japanese, while they may also

speak, read, and write one or more other languages. More than 50% are retired baby boomers,

while the majority of the remaining demographic is married, lower-middle to upper-middle class,

and they visit their physician for annual check-ups. They are educated, fairly well read and

engaged in current events and the nightly news (Lavelle, 2004).

They are at risk for osteoporosis due to their ethnic background, fail to eat right all the time, may

be calcium deficient, and taking a prescribed drug for gastric reflux or anxiety, which also causes

bone loss. They drink alcohol occasionally, don’t get enough sleep, fail to exercise regularly and

more often than not, find themselves stressed.


6

Primarily, our intended audience is aging baby boomers and bone loss is a fact of life. They are

uniquely susceptible and highly likely to become victims of osteoporosis.

Marketing Channel Strategies

The Health Belief Model is relative to the interpersonal / individual level theory, the assumption

here is that people will change their prospective attitude if they feel at risk. They must believe

that the risk of the threat can be overcome with a change in behavior. Overall, the belief must be

relative to behavior changes and the costs of those changes, while true benefits of the change,

must exceed the cost. Below are the six factors relative to the health belief model for the

prospective program.

Osteoporosis Awareness and DXA Testing:

1. Perceived susceptibility - present people of the perspective age groups, ethnicities, and

demographic discussing osteoporosis. (TV)

2. Perceived severity - deliver statistical data on deaths from osteoporosis through a video

format with actual severely stricken patients. (TV)

3. Perceived benefits - present the option of DXA testing and the proper medication

alleviating the risk factors. (TV, radio, web banners)

4. Perceived barriers - design messaging that will glorify the behavior change, centered

around, happy, healthy, longer lives. (TV, radio, YouTube)

5. Cue’s to action - we will develop our campaign with the intent that husbands and wives

get tested together, public service announcements. (Direct mail-Posters)


7

6. Self-efficacy - convince the audience the simplistic nature of the behavior. (Social media,

YouTube)

Our primary objective is the baby boomer generation as they may be the only remaining segment

of the population that actually reads the newspaper, watches hours and hours of television, and

are responsible for 40% of the entire consumer demand in the country today. Baby boomers have

also become quite tech savvy, they utilize the web, social media, and they understand the nuances

of the digital age.

The strategy will be an integrated approach, utilizing a specific blend of media. Our direct mail

and poster campaign will host the same colors and styles, as we would like our audience to easily

recognize the messaging. The television and radio commercials will have the same voice-over

personality and the same actors will be shown in each production. The statistics utilized will be

identical regardless of format or medium, always delivering the same exact message. We will

align and brand our program with the intent to create an atmosphere for osteoporosis awareness

(IMC WVU Lesson 7, 2013).

Message and Promotional Strategy

The osteoporosis and DXA testing awareness campaign “Request-the-Test”, attempts to secure

the attention of baby boomers nationwide. “Request-the-Test” plans an onslaught of television,

radio, social media, and direct mail to spoon feed its message to the intended audience. While

hospitals, clinics, and primary care physicians will be displaying numerous posters, cards, and

calendars with the message, “Request-the-Test”. This unique alliance between the campaign and


8

medical practitioners is designed to inform patients and encourage testing. While also directing

them toward the toll free number (800-DXA-TEST) for more information, and the website

(www.GetTested.com/DXA) where they will directed to an osteoporosis center for DXA testing.

Ideally the campaign is designed to introduce the severe risks of osteoporosis to the patient

population who are most threatened. The campaign seeks to offer clinical information that will

support the claim, such as this statistic that “one out of every two women over the age of 50 will

suffer a fracture related to osteoporosis”(NOF.org, 2013). This is truly an emotional plea that the

campaign would like to deliver to each and every patient’s living room. The idea is to create a

sense of urgency, convince those at risk that if they “Request-the-Test”, a simple 15-second test

may change their lives forever. Patients who are tested and diagnosed with early onset

osteoporosis can be successfully treated, while treatment helps them maintain independence and

mobility. The campaign is loss framed with the intent to illicit fear of the disease and its

crippling effects, while also impressing upon them the potential for death.

Campaign Evaluation

The campaign will evaluate phase one of the media blitz by evaluating the increase in the number

of DXA screening within the regions surveyed. A key deliverable would an increase in the overall

number of exams compared to the average numbers for that particular timeframe the previous

Before you lose it for good…

Request-the-Test!

1-800-DXA-TEST


9

year. Process measures will be reviewed as well, the number of calls received during the media

campaign to 800-DXA-TEST. The internet site will be monitored as well, how many hits on a

daily, weekly, and monthly perspective, as well as the number of patient information downloads.

Email requests for information, with regard to osteoporosis clinics, physicians, and general

osteoporosis information will be assessed. The campaigns two videos, “Get Tested Today!” and

“Ask Your Doctor About DXA”, both available on YouTube, will be tracked for downloads and

overall consumer interest.

When the numbers from each outlet are determined the “Request-the-Test” team will evaluate

each option, and make changes and adjustments as needed. If necessary, resources will then be

reallocated toward different outlets to better serve the campaign or new media sources may be

utilized to enhance the message.

Implementation

The distribution plan is tied to their “Request-the-Test” packets which will be sent on May 31,

2013, the packets will be sent to 150 hospitals, clinics, and primary physician offices throughout

the United States. The packet contains posters, videos, appointment cards, calendars, and stickers

all focused on osteoporosis awareness and the campaign “Request-the-Test”. The kits contents

will be distributed once, this one time printing was provided by USA Printing free of charge.

There will be a CD in each packet as well as PDF’s, which will allow users to create or print

more material as needed. The PDF’s will also be available on the website, and through the

campaigns partner organizations, National Osteoporosis Foundation, National Bone Health

Alliance, American College of Rheumatology, and The Bone and Joint Initiative.


10

Hill Holiday of Boston will be providing pro bono advertising and marketing communications

assistance to the campaign. Hill Holiday is one of the top agencies in the country, and they will

develop, plan, and organize the entire PR and media campaign. Beginning with the press release

to all media outlets, and then followed up with the introduction of the campaign video “Get

Tested Today”, which will presented every other hour for the entire day on the Time Square

jumbo screen.

The campaign has been guaranteed funding from several sources, corporate sources and DXA

manufacturers General Electric and Hologic, along with a National Institute of Health grant and a

grant from the Getty Health Foundation. ”Request-the-Test” will also attempt to raise funds

through the website www.GETTESTED.COM and the toll free hotline 800-DXA-TEST.

If funding is maintained, this campaign can make a difference with regard to osteoporosis

awareness while increasing DXA testing. “Request-the-Test” has the ingredients for success,

possessing strong messaging, for a cause that is undeniable.

http://www.gettested.com/


11

Reference

Western Washington University (2013) Center for healthy living-Demographics, Retrieved from:

http://www.wwu.edu/healthyliving/education/osteoporosis/demographics.shtml

Brody, J (2011) A Reminder on Maintaining Bone Health, Retrieved from:

http://www.nytimes.com/2011/11/01/health/a-reminder-on-bone-health-and-osteoporosis.html

Goldstein, S (2011) What is the optimal interval for osteoporosis screening in postmenopausal

women before fracture occurrence and osteoporosis treatment initiation, Retrieved from:

http://www.obgmanagement.com/article_pages.asp?AID=10653

AAOS (2013) Osteoporosis and Bone Health, Retrieved from:

http://www.aaos.org/news/aaosnow/may09/clinical8.asp

Lavelle, P (2004) Osteoporosis, Retrieved from:

http://www.abc.net.au/health/library/stories/2004/04/29/1831468.htm#.UYhyJr_Q50o

WVU IMC PI Reed School of Journalism (2013) Lesson 2 – Theory Review of Health Behavior

Change, Retrieved from:

https://ecampus.wvu.edu/webct/urw/tp0.lc5116001/cobaltMainFrame.dowebct

WVU IMC PI Reed School of Journalism (2013) Lesson 7 – Selecting Health Message Channels,

Retrieved from: https://ecampus.wvu.edu/webct/urw/tp0.lc5116001/cobaltMainFrame.dowebct

Baby Boomer-Magazine.com (2013) Who are the baby boomers, Retrieved from: http://www.babyboomer-magazine.com

WVU IMC PI Reed School of Journalism (2013) Lesson 6 – Developing Health Messages,


WVU IMC PI Reed School of Journalism (2013) Lesson 9– Implementing Health Campaigns,

Retrieved from: https://ecampus.wvu.edu/webct/urw/tp0.lc5116001/cobaltMainFrame.dowebct WVU IMC PI Reed School of Journalism (2013) Lesson 8 – Evaluating Health Campaigns,


http://www.wwu.edu/healthyliving/education/osteoporosis/demographics.shtml

http://www.nytimes.com/2011/11/01/health/a-reminder-on-bone-health-and-osteoporosis.html

http://www.obgmanagement.com/article_pages.asp?AID=10653

http://www.aaos.org/news/aaosnow/may09/clinical8.asp

http://www.abc.net.au/health/library/stories/2004/04/29/1831468.htm#.UYhyJr_Q50o



http://www.babyboomer-magazine.com/




osteoporosis awareness-nbha- wclarke-052013

Healthcare