Genetic factors exert a strong influence on peak bone mass, but controllable environmental and lifestyle factors also play a role. These include good nutrition, particularly adequate calcium and vitamin intakes. Only 10 percent of girls and 25 percent of boys between ages 9 and 17 obtain an adequate amount of calcium in their diet through the consumption of dairy products and vegetables. There is strong evidence that physical activity early in life contributes to higher peak bone mass. Clinical trials have shown that exercise reduces the risk of falls by approximately 25 percent.
Falls are a major cause of fractures in people with osteoporosis.
Although hormone replacement therapy remains a common treatment and prevention option, the panel suggested that more information is needed on how estrogen alone or in combination with other treatments reduces the incidence of fractures. Natural estrogens, such as plant-derived phytoestrogens, have thus far not been shown to reduce fractures. Among the new classes of drugs are bisphosphonates and selective estrogen receptor modulators. New technologies have improved the detection of loss of bone mineral, a key predictor of osteoporotic fracture. Other measures of bone strength, such as ultrasound of the heel, are as effective in predicting hip fracture.