K O O'Brien, Johns Hopkins University, Baltimore,


© 2005 Elsevier Ltd. All rights reserved.

Optimal dietary intake is essential for bone health. During childhood and the pubertal growth spurt, nutrients are needed to fully consolidate skeletal mass and to ensure the attainment of a peak bone mass consistent with one's genetic potential. After peak bone mass is obtained, nutrition continues to play an essential role in skeletal health. If intakes of key nutrients are not consumed at required levels, mineral may be lost from bone or essential bone proteins may not be fully functional.

Osteoporosis and osteopenia are substantial public health problems. Low bone mass (osteopenia and osteoporosis) and vitamin D deficiency are currently substantial public health problems. Osteopenia is defined when adult bone mineral density values are 1-2.5 SD below the mean peak value observed in a young adult. If the deficit in bone is more pronounced, and bone mineral density falls 2.5 SD or more below that observed in a young adult, this is defined as osteoporosis. Approximately 200 million people worldwide have osteoporosis. Many more have suboptimal bone mass and are at increased risk of developing this disease. Vitamin D deficiency in adults can also impair bone mineralization and lead to osteomalacia (in adults) or rickets (if evident in pediatric age groups prior to the completion of longitudinal bone growth). Insufficient bone mass and impaired bone mineralization increases the risk of fractures at considerable cost and loss of quality of life. Because bone loss is not fully reversible, the most effective strategies for reducing osteoporosis should focus on prevention, with nutrition playing a key role.

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