NOF & ASN’s Recommendations on Peak Bone Mass Throughout Life

One in two women and up to one in four men age 50 and older are estimated to break a bone due to osteoporosis in their lifetime. Improving the amount of bone mass developed during youth and achieving optimal bone mass is a key strategy to reduce the risk of osteoporosis and future bone fractures. While peak bone mass is affected by numerous factors, the good news is that approximately 20-40 percent of adult peak bone mass is influenced by lifestyle factors that are under one’s control.

On February 8, the National Osteoporosis Foundation and the American Society for Nutrition (ASN) published a joint scientific position statement to provide an update of the latest research on peak bone mass development and lifestyle recommendations for optimal bone health.

Researchers conducted a systematic review of articles published between 2000 and 2014 that focused on dietary and lifestyle factors related to bone mass and strength in children and adolescents. They used a grading system to rate the strength of the evidence. Several diet and lifestyle factors scored high for their impact on bone health. Specifically, getting enough calcium and physical activity (effect on bone mass and density) both received a grade of “A,” while getting enough dairy, vitamin D and physical activity (effect on bone structural outcomes) received a “B.” These were the highest scores awarded for any nutrient, food or lifestyle factor.

When examining the evidence supporting dairy food consumption, all three of the randomized controlled trials reported since 2000 showed increased total bone mineral density in at least some skeletal sites (i.e., hip, spine) in adolescent girls with dairy food consumption (Merrilees et al., 2000; Du et al., 2004; Cheng et al., 2005).

The scientific statement builds on earlier evidence from randomized controlled trials, re-confirming that consumption of dairy foods can help build peak bone mass. That is not surprising, considering dairy foods, like milk, cheese and yogurt, are the No. 1 food source of both calcium and vitamin D in the diets of children and adults, and also contain high-quality protein and significant amounts of potassium and phosphorus, which support bone health.

This report reinforces the importance of dairy foods, calcium and vitamin D in supporting bone health, and is in agreement with existing professional and government organizations that have recognized the importance of dairy foods and calcium for bone health, including the 2015 Dietary Guidelines for Americans (DGA), American Academy of Pediatrics, National Institutes of Health and Food and Drug Administration.

There are still gaps in our knowledge and further research is needed. For example, there is a critical need for more research focusing on youth at different growth stages and the interaction between genetics, environment and lifestyle and how this may impact the development of peak bone mass.

Even though more research is needed, there are things you can act on now to help your clients understand how to improve their bone health. This report should give you new impetus to continue to encourage recommended amounts of calcium and vitamin D, dairy foods and physical activity – especially in youth, but throughout life.  

Check out this new collection of educational tools developed for World Osteoporosis Day to help in this effort.