Optimizing peak bone mass: what are the therapeutic possibilities?

Bone mass in the elderly depends on the rate of involutional bone loss and on the peak bone mass, i.e. the bone mass present around the third decade of life. Factors relating to the attainment of peak bone mass include congenital factors, diet, hormones, physical activity, life-style factors, drugs and diseases. A therapeutic intervention aimed at increasing peak bone mass is conceivable only by controlling factors such as estrogen status, dietary calcium intake and physical activity. Calcium intake appears to be relevant up to the so-called threshold intake (1000 mg/day), but higher allowances do not seem to offer additive advantages. Exercise affects only the regions of the skeleton under mechanical stress. Estrogen administration is realistic only in conditions characterized by severe hypoestrogenism.