Parallels between nutrition and physical activity: research questions in development of peak bone mass.

Lifestyle choices are attributed to 40% to 60% of adult peak bone mass. The National Osteoporosis Foundation (NOF) sought to update its 2000 consensus statement on peak bone mass and partnered with the American Society for Nutrition, which, in turn, charged a 9-member writing committee with using a systematic review approach to update the previous NOF guidelines. PubMed searches of the scientific literature from January 2000 through December 2014 were conducted on all relevant lifestyle choice factors and their relation to increasing bone mass during childhood and adolescence. The writing group concluded that there is strong evidence for the benefits of physical activity and calcium intake on bone mass accretion, moderately strong evidence for the benefits of vitamin D and dairy intake on bone mass and for physical activity on bone structure, and weaker evidence for other lifestyle choices. There were parallels and synergies between the benefits of diet and exercise on development of peak bone mass, but the type of evidence and public policy recommendations in the two disciplines differ in several important ways. Nutrition uses a more reductionist approach in contrast to physical activity, which uses a more global approach. This leads to differences in research priorities in the 2 disciplines. The disciplines can advance more quickly through collaboration and adoption of the best approaches from each other.