Bone-Health Challenge

CHRISTINA VEIDERS

The profile of the bone-debilitating disease osteoporosis appears an ideal target for food retailers to rally their support behind.

First, the gender affected most are women, supermarkets' core customers. Of the 10 million people in the United States estimated to be suffering from the disease, 80% are women, according to the National Osteoporosis Foundation.

It's a silent disease with bone loss occurring over a long period of time, and many don't realize they have the condition or that they are susceptible to developing it. There are nearly 34 million people in the country with bone loss, placing them at high risk.

Eating the right foods and fortifying the body with nutritional supplements to support bone health are important preventive measures. Supermarkets are ideally positioned to disseminate bone-health information and provide education to a growing population of Baby Boomers who are at high risk for developing the disease. Medications such as bisphosphonates like Fosamax, Boniva and Actonel or other antiresorptive drugs such as Fortical, Miacalcin, Prolia and Evista have been found effective in controlling the disease.

The U.S. Food and Drug Administration recently approved Amgen's new drug, Prolia, to treat osteoporosis in postmenopausal women. Treatment with the new drug will cost $1,650 per year for two injections, according to media reports.

The market for non-drug bone-health-related products also is growing rapidly in conjunction with greater awareness of the disease. Nutrition Business Journal, a sister publication of SN, reported the bone-health condition-specific market grew by 16% in 2008 to about $1.7 billion. Calcium represents 60% of the market, multivitamins 19%, vitamin D 14% and magnesium 5%. It was estimated that retail sales of calcium reached $1.1 billion in 2008, growing 6%, while magnesium grew 14% to $310 million and vitamin D sales grew 117% to $230 million. While the prescription drug market for bone disease grew at a slower rate of 5.5%, it amounted to more than $6 billion in revenue in 2007.

While calcium and vitamin D dominate the non-drug product segment, there are many other ingredients related to maintaining healthy bones as well, including zinc and phosphorus, and vitamins B6, B12 and folic acid.

The costs related to the disease are significant. Osteoporosis-related fractures were responsible for an estimated $19 billion in costs in 2005. That figure is expected to rise to approximately $25.3 billion by 2025, according to NOF data.

Osteoporosis vies with other high-profile diseases such as heart health, obesity and cancer when it comes to retailers providing services on prevention and management of chronic diseases. Yet, there is a growing public awareness of osteoporosis along with clinical research about the risks of bone-related illnesses.

All the statistics point to a chronic disease that supermarkets with pharmacies could target to grow their image as a health and wellness provider, drive traffic to the store and generate an additional revenue stream.

However, nearly a decade after a landmark study on osteoporosis was conducted at Ukrop's Super Markets, Richmond, Va., which was acquired by Ahold last year and is now operated under the Martin's banner by Ahold's Giant-Carlisle division, that showed potential as a revenue generator for pharmacy, supermarkets have yet to develop similar models and get behind community outreach programs targeting bone disease.

CLASSIC CASE STUDY

In 2001-2002, the supermarket industry represented by Ukrop's Super Markets conducted an outreach project, in conjunction with the American Pharmacists Association Foundation, Washington, called Project Impact: Osteoporosis. The project involved participation at some of Ukrop's 22 pharmacies in the 29-store regional chain. The objective, explained Benjamin Bluml, vice president of research for the APhA Foundation, who helped develop the chronic care model for the study, was to work with a regional pharmacy chain and get health insurance reimbursement for pharmacy management services for those found to have osteoporosis. The program was straightforward with Ukrop's doing a good job letting those in the community know they were conducting the program and would provide bone-mineral-density screening services with possible referral to physicians.

A total of 532 patients were screened for the disease of which 78% were either at moderate or high risk for future fractures. Compared to screening for other chronic diseases like diabetes or cholesterol which may produce double-digit percentages for people at risk, Ukrop's osteoporosis screenings of those at risk was over the top and surprising, Bluml told SN.

Also, the services being offered were considered valuable by patients who paid $25 out of pocket for the screenings. Of those screened, 37% were found to be in high risk, 33% moderate risk and 30% low risk for future fracture. In the moderate- and high-risk groups, 37% of patients scheduled and completed a physician visit, 19% went on to have a further diagnostic scan and 24% of those patients were initiated on osteoporosis therapy.

In addition, participating pharmacies received payment for both the osteoporosis screening as well as the collaborative health management services performed. “It was a well-defined project and UnitedHealthcare paid for the pharmacy management services, which was a big deal at the time,” Bluml said.

While the results of the project were promising in providing an important community health service to a growing population susceptible to the disease and as a potential revenue generator that crossed into other in-store departments, the project ended and there has been no further development, nor have other supermarket chains picked up the program.

John Beckner, director of pharmacy at Ukrop's at the time, spearheaded the project. Beckner, now with Martin's, was not immediately unavailable for comment on why the study hasn't gone further in food retailing.

During an interview late last year, Beckner did tell SN that such programs presented challenges in time and labor to execute and in gaining the full support from other store departments in promoting the supermarket as a destination for health-related conditions. He also noted that getting pharmacy reimbursement for disease-state management services was inconsistent.

While a pioneer for several disease-state programs like osteoporosis over the years, Beckner has since focused on diabetes, the seventh-leading cause of death in the United States.

Bluml acknowledged that diabetes is more prevalent than osteoporosis with some 23.6 million people having the disease, or 7.8% of the population. He surmised that a reason why the osteoporosis program hasn't been championed by food retailers has to do with the investment required in heel sonogram machines, which cost about $10,000 at the time of the study. The bone-density-mineral measuring devices are used to predict the risk of future fractures. The cost of the machines used in the Ukrop's study was underwritten by an educational grant, said Bluml. As opposed to the technologically advanced DEXA scans, heel sonogram machines are needed to stratify the risks of future fracture and to predict those at moderate or high risk.

“Our job is to create evidence that if you put these things in place they can actually work,” said Bluml. “You could break even and over time create a revenue stream,” he said, and the size of the investment made in screening devices can be made up in the repeat traffic of patients diagnosed with the disease.