The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations
- PMID: 26856587
- PMCID: PMC4791473
- DOI: 10.1007/s00198-015-3440-3
The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations
Erratum in
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Erratum to: The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations.Osteoporos Int. 2016 Apr;27(4):1387. doi: 10.1007/s00198-016-3551-5. Osteoporos Int. 2016. PMID: 26935424 Free PMC article. No abstract available.
Abstract
Lifestyle choices influence 20-40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. [Table: see text] Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years-a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one's genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.
Keywords: Bone mineral content; Diet; Nutrition; Peak bone mass; Physical activity.
Conflict of interest statement
Endorsing societies
This scientific statement has been reviewed and endorsed by the following scientific societies:
American Bone Health
American College of Sports Medicine
Endocrine Society
National Osteoporosis Foundation
Society for Women’s Health Research
Reviewers
This scientific statement was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Osteoporosis Foundation in making this published report as sound as possible and to ensure that the report meets standards for both objectivity and evidence. We thank the following individuals for their peer review of this scientific statement:
Sue A. Shapses, PhD
Rutgers, The State University of New Jersey
Kimberly O’Brien, PhD
Cornell University
Urszula T. Iwaniec, PhD
Oregon State University
This scientific statement was peer reviewed by the National Osteoporosis Foundation Research Committee and
Sources of financial support
Funding for the manuscript was provided by the Alliance for Potato Research and the Dairy Research Institute.
Conflicts of interest
TCW is employed by the National Osteoporosis Foundation. CMW, CMG, KFJ, HJK, JML, RL, MO, and BSZ have no disclosures.
Figures
Comment in
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Soccer and bone development.Osteoporos Int. 2016 Oct;27(10):3133-4. doi: 10.1007/s00198-016-3599-2. Epub 2016 Apr 14. Osteoporos Int. 2016. PMID: 27080705 No abstract available.
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2016 The Year That Was: Bone Strength.Pediatr Exerc Sci. 2017 Feb;29(1):23-25. doi: 10.1123/pes.2016-0279. Pediatr Exerc Sci. 2017. PMID: 28271807
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