Understanding ARPA-H and Its Potential Impact

If you haven't encountered ARPA-H yet, you likely will soon. The acronym stands for "Advanced Research Projects Agency for Health," a new entity established in March 2022 under the US Department of Health and Human Services, as part of the National Institutes of Health (NIH).

This agency began with a robust budget of $1.5 billion and a significant mission. It was created due to the perception that current government health initiatives progress too slowly and incrementally. ARPA-H's goal is to discover groundbreaking biomedical and health solutions that can provide transformative, sustainable, and equitable health options for everyone. According to its inaugural Director, Dr. Rene Wegrzyn, the agency aims to make bold, unconventional moves, focusing on challenges that appear impossible but are merely improbable.

Choosing the Right Challenges to Address

How are projects selected for ARPA-H?

Visionaries with strong credentials are invited to apply on a platform aptly named "Transform The Future." Those chosen as "Program Managers" enjoy lucrative positions, earning up to $400K, with budgets ranging from $50M to $100M to confront health issues holistically. The selection process is swift.

I urge this community to help identify an exceptional program manager focused on bone health, particularly osteoporosis. This condition represents an unacknowledged wave that will soon impact millions. Its effects extend beyond the individuals diagnosed, influencing unpaid caregivers, the healthcare system, and the labor force.

The Toll of Osteoporosis on Society

Approximately half of all individuals over the age of 50 are susceptible to osteoporosis, a condition characterized by reduced bone mass and brittle bones. While anyone can develop this disease, around 80% of those affected are women.

The consequences are severe: one in four men and one in two women will suffer a fracture during their lives due to osteoporosis. These breaks typically occur in the hip, wrist, or spine, with hip and spine fractures significantly increasing mortality rates. For those who survive, independence and quality of life often decline swiftly after such injuries. Consequently, although women generally live longer than men, their final five years frequently involve reliance on others for basic daily activities.

The financial burden of caring for older adults with osteoporosis-related fractures is already staggering, amounting to $19 billion annually for patients, families, and caregivers. This is alarming, considering that the population aged over 50 was 117 million in 2019 and is projected to reach 157 million by 2050. The financial implications of osteoporosis are expected to escalate to $25.3 billion by 2025, with further increases anticipated.

The Necessity for Bold Solutions

Currently, osteoporosis has no cure. Given the scale of this impending epidemic and its ramifications, a bold approach is essential. An ARPA-H initiative could tackle various aspects, including:

1. Education: It is crucial for every child and parent to understand that bone mass peaks between ages 10 and 20. During this time, regular exercise and a diet high in calcium and vitamin D can foster healthy bones. A nationwide campaign is needed to motivate children, especially girls, to take preventive actions in their teenage years to avoid becoming dependent in their later years.
2. Prevention: Bones often transition to a thinner state before becoming osteoporotic. Awareness of one's osteopenic status can lead to lifestyle modifications, such as increased exercise, enhanced calcium and vitamin D intake, and reduced alcohol consumption, which could slow the disease's progression. Promising innovations, such as clinical trials by Bone Health Technologies, are exploring devices that could stimulate bone growth in osteopenic patients, but further advancements are necessary.
3. Diagnosis: Early detection is key. Currently, bone density is assessed using DEXA (dual-energy X-ray absorptiometry) scans, recommended for women over 65 and men over 70, costing between $150 and $325. When covered by insurance, the out-of-pocket expense may be $30. Innovations to reduce costs and enhance accessibility to these scans could save lives, ideally introducing screening for women at age 50.
4. Support for Caregivers: As the elderly population grows, so does the strain on unpaid caregivers, 75% of whom are women. They often devote hours equivalent to full-time jobs to caregiving, impacting their own employment and financial stability. An ARPA-H initiative could explore not only ways to reduce the incidence of osteoporosis but also improve care strategies within both formal and informal healthcare systems.
5. Connecting Patients with Treatment Options: While osteoporosis remains incurable, long-term treatment options have improved. However, many high-risk patients remain unrecognized and untreated, leading to preventable fractures and deaths. A comprehensive ARPA-H program could expedite the search for additional treatments and develop policies to identify and support those in need of long-term care.

The establishment of ARPA-H presents an opportunity to demonstrate that the government can effect significant change. Let's identify the leader who can advocate for addressing the silent epidemic of osteoporosis.

Anna Zornosa is an investor, advisor, and consultant focused on early-stage companies, particularly those founded by women or centered on technology-enabled women's health. She also serves as an Entrepreneur in Residence with the SEED office at the National Institutes of Health.