The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations

摘要

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 ). 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. [] 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 []. frame="hsides" rules="groups" class="rendered small default_table">> rowspan="1" colspan="1">Lifestyle Factor rowspan="1" colspan="1">Grade> colspan="2" rowspan="1"> Macronutrients > rowspan="1" colspan="1"> Fat rowspan="1" colspan="1">D> rowspan="1" colspan="1"> Protein rowspan="1" colspan="1">C> colspan="2" rowspan="1"> Micronutrients > rowspan="1" colspan="1"> Calcium rowspan="1" colspan="1">A> rowspan="1" colspan="1"> Vitamin D rowspan="1" colspan="1">B> rowspan="1" colspan="1"> Micronutrients other than calcium and vitamin D rowspan="1" colspan="1">D> colspan="2" rowspan="1"> Food Patterns > rowspan="1" colspan="1"> Dairy rowspan="1" colspan="1">B> rowspan="1" colspan="1"> Fiber rowspan="1" colspan="1">C> rowspan="1" colspan="1"> Fruits and vegetables rowspan="1" colspan="1">C> rowspan="1" colspan="1"> Detriment of cola and caffeinated beverages rowspan="1" colspan="1">C> colspan="2" rowspan="1"> Infant Nutrition > rowspan="1" colspan="1"> Duration of breastfeeding rowspan="1" colspan="1">D> rowspan="1" colspan="1"> Breastfeeding versus formula feeding rowspan="1" colspan="1">D> rowspan="1" colspan="1"> Enriched formula feeding rowspan="1" colspan="1">D> colspan="2" rowspan="1"> Adolescent Special Issues > rowspan="1" colspan="1"> Detriment of oral contraceptives rowspan="1" colspan="1">D> rowspan="1" colspan="1"> Detriment of DMPA injections rowspan="1" colspan="1">B> rowspan="1" colspan="1"> Detriment of alcohol rowspan="1" colspan="1">D> rowspan="1" colspan="1"> Detriment of smoking rowspan="1" colspan="1">C> colspan="2" rowspan="1"> Physical Activity and Exercise > rowspan="1" colspan="1"> Effect on bone mass and density rowspan="1" colspan="1">A> rowspan="1" colspan="1"> Effect on bone structural outcomes rowspan="1" colspan="1">B >Table 1Evidence grading system