The accrual of bone mass during childhood and puberty

Purpose of review To assess factors that influence the tempo of bone mass accrual with emphasis on obesity, exercise, and nutritional factors. Recent findings The prevalence of childhood obesity has increased dramatically throughout the world. Recent studies suggest that adiposity may be detrimental to development of bone strength parameters, and bone mass accrual during growth. Weight-bearing exercise during prepubertal and peripubertal period appears to enhance bone strength parameters. Maternal ultraviolet B radiation exposure and vitamin D status has been shown to have a positive effect on neonatal bone status, which appears to track up to the prepubertal period. Administration of vitamin D with or without calcium, but not calcium alone, during the prepubertal period might be an important 'window' for improving skeletal mineralization. Summary Obesity in children appears to be detrimental to development of bone strength parameters and bone mass accrual. Weight-bearing exercise during prepubertal and peripubertal period and vitamin D supplementation during pregnancy, infancy, and peripubertal period might be important for bone mass accrual. However, adequately powered randomized controlled trials with follow-up into adulthood are needed to determine if these interventions improve the tempo of bone mass accrual.