Peak Bone Mass Formation: Modern View of the Problem

Abstract

Peak bone mass is the amount of bone tissue that is formed when a stable skeletal state is achieved at a young age. To date, there are no established peak bone mass standards nor clear data on the age at which peak bone mass occurs. At the same time, the level of peak bone mass at a young age is an important predictor of the onset of primary osteoporosis. The purpose of this review is to analyze the results of studies of levels of peak bone mass in general, the age of its onset, as well as factors influencing its formation. Factors such as hormonal levels, body composition, physical activity, nutrition, heredity, smoking, lifestyle, prenatal predictors, intestinal microbiota, and vitamin and micronutrient status were considered, and a comprehensive scheme of the influence of these factors on the level of peak bone mass was created. Determining the standards and timing of the formation of peak bone mass, and the factors affecting it, will help in the development of measures to prevent its shortage and the consequent prevention of osteoporosis and concomitant diseases.

Keywords: PBM; aBMD; bone mineral density; peak bone mass.

Figure 1

Endogenous and exogenous factors affecting PBM.

Figure 2

Mechanisms of the influence of risk factors on the formation of peak bone mass. The figure shows a simplified version the molecular mechanisms of modeling and remodeling of bone tissue and possible factors of an endogenous and exogenous nature that can influence certain links of pathogenesis. MCSF—macrophage colony-stimulating factor; TNFRSF11 (RANKL)—tumor necrosis factor superfamily member 11 (tumor necrosis factor ligand superfamily member 1); PGE₂—prostaglandin E₂; SCFAs—short-chain fatty acids; OPG—osteoprotegerin; SOST—sclerostin gene; DDK1- Dickkopf WNT signaling pathway inhibitor 1; OSX1—osteoblast-specific transcription factor Osterix; RUNX2—runt-related transcription factor 2; + denotes positive influence; − negative influence.