The final stages in development of peak bone mass (PBM) take place in late adolescence or early adulthood and are vital for attaining optimal bone health. The variation in bone mineral density (BMD) at the time of PBM is similar with aging, suggesting that the benefits of efforts to enhance BMD early will later be realized with aging. Therefore, optimization of PBM and maintenance of BMD are thus the best population health strategies in the primary prevention of osteoporosis and reduction in risk of fracture.