American Society of Osteoporosis Providers
Edition 10
October 2026
Over the past four months, this newsletter has asked a question the field has never answered systematically: what would it take to make bone health visible? The three-part series, A Field That Can't See Itself, traced that problem through patients who cannot be identified before they fracture, fracture events that cannot be distinguished in the data, and providers who cannot be counted or assessed against a shared standard. The measurement framework has been proposed nationally.
This issue opens a new thread. Not about what we cannot count. About what happens to the programs we have already built when the person holding them together leaves.
Workforce the Field Can't See
What happens when a bone health program loses the person who held it
A 2025 systematic review by Kesselman and colleagues found no published discontinuation rate for bone health programs. The literature describes programs that survived. It does not describe what happened to the ones that did not.
That absence is not a data gap. It is a structural one. Fracture liaison services and bone health clinics are built around clinical champions, individual providers whose expertise and commitment hold the program together. National guidance documents describe the champion role as essential. None of them describe what happens when that person retires, relocates, or burns out.
The field has no method for replacing them.
This is not about hiring. Institutions facing a champion departure typically reach for familiar solutions: recruit a replacement, document the workflow, distribute tasks across a team. These are reasonable management responses. None of them transfers clinical competency in bone health care at the level required to sustain a specialized program.
The training environment reinforces the problem. Between 250 and 325 hours of continuing medical education content is available in the bone health space today. That is not a shortage of supply. It is a surplus of fragments. Providers can accumulate credits across dozens of offerings without encountering a structured, competency-defined base that could prepare them to operate a bone health service line independently.
One Instance, Observed
Campbell Clinic is one of the largest orthopedic practices in the United States. Its bone health clinic had run for seven years on what one clinician knew. When that clinician announced a planned retirement in late 2025, the practice did what most institutions do: it hired a successor. A new clinician started in mid-2025, roughly a year before the departure. Overlap was built into the plan.
It was not enough. Overlap is not knowledge transfer. Hiring a successor is not a succession plan. By the time the departing clinician left in May 2026, the program was at real risk of closing.
ASOP engaged with Campbell Clinic to deploy a structured onboarding curriculum designed to transfer the clinical knowledge required to operate the bone health service line. The practice brought a cohort of its own clinicians through the curriculum. Most of them were experienced orthopedic providers with limited prior bone health background. The curriculum was not a lecture series. It was built as a reproducible workforce pipeline, a defined sequence that could take a new provider from entry point to functional independence in bone health care.
The program has now absorbed the departure of trained staff without losing capability. Where it previously ran on a single clinician, it is now delivered by multiple providers. It is taking on more than it did before, including patients referred from outside the practice and patients who have not broken a bone but are at risk.
This is the first documented instance we are aware of in which a bone health program survived provider turnover through a structured workforce method rather than individual recruitment.
In Dr. Cosgrove's words:
"The bone health clinic at Campbell Clinic was at real risk of closing following the loss of its primary clinician. We were faced with a choice: sunset the program or develop and train a new workforce capable of sustaining it."
"ASOP's curriculum helped distill a complex onboarding challenge into a reproducible workforce pipeline at our site. That stability has allowed Campbell Clinic to plan for the future and 'build the bench,' making the service line less vulnerable to the disruption that can accompany the departure of an individual provider."
There are honest limits to what one site shows. This is a single institution, observed over months rather than years. The work has not been peer-reviewed. But it demonstrates that the question is answerable. A structured method can sustain a bone health program through provider transitions that would otherwise end it.
Dr. Cosgrove's team is now extending this work further:
"It has also allowed us to extend our educational programming into bone health. The ASOP curriculum will serve as the backbone of the bone health training within our upcoming APP fellowship program, a key mechanism for training the next generation of bone health providers in our region and, hopefully, a model that can help build broader national momentum around development of the bone health workforce."
A program that was nearly lost is becoming a training site for the next generation. That is the difference between a program built around a person and a program built around a standard
→ Read Building the Field in full at theasop.org/building-the-field
Read the full article, including references and a discussion of what this does and does not prove
Save the Date: November 30
ASOP's First Virtual Public Meeting
ASOP is holding its first virtual public meeting on November 30, 2026. We will present what we are doing to build the infrastructure the bone health space requires, followed by open Q&A.
If you have followed this newsletter, followed the LinkedIn series, or heard about ASOP through a colleague, this is the meeting where you can ask the questions you have been carrying. No pitch. No sales deck. Just who we are, what we have been building, and your questions.
Details and registration information will follow in the coming weeks.
The Founders Forum
If what you just read made you want to say something, there is a place for that.
The Founders Forum launched this summer as a series of intimate conversations with the people closest to bone health care. The first sessions are underway, and the voices joining are exactly the ones this was built for: clinicians, program builders, and ecosystem professionals who have been doing this work and have something to say about where it needs to go.
ASOP is building its Founders Forum: a small circle of people who want to help shape this organization during the period when its direction is still being set.
This is not a donor tier. It is a working relationship for people who see what ASOP is building and want to be part of it while the concrete is still wet. Founders Forum members have direct access to the thinking, strategy, and decisions shaping the future of bone health workforce development.
Be a Part of the Future of Bone Health
Everything described in this newsletter, the workforce standard, the measurement framework, the infrastructure that connects identification to treatment, is being built right now. Not by a large institution. Not by a legacy organization. By a small group of people who decided the field needed it and started building.
ASOP is actively building committees that will define how bone health is delivered in the future: certification standards, assessment frameworks, and the question development and validation process that determines what clinical competency in bone health actually means.
This is not passive membership. This is an opportunity to directly shape the standards your field will use, before they are set.
We are focused on full membership for clinicians who want to help build this work, not just receive it.
Stay Engaged Between Newsletters
ASOP publishes substantive content on LinkedIn each week. Not announcements, but real conversations about how bone health care functions in the real world and what it will take to improve it.
Systems Monday: how care infrastructure works and where it breaks down
Literature Thursday: what the evidence actually says, and what it doesn't
Membership Matters: the providers building the future of this field
If you're not following along, you're missing how this is evolving in real time.
ASOP is building the workforce pipeline and infrastructure to recognize, support, and manage bone health risk across the lifespan, aligned with science and standards, independent of products and platforms, and focused on the full arc of patient care.
Best Regards,
Dudley Phipps
CEO/Executive Director