Osteoporosis is the most common of all skeletal disorders. The most commonly accepted definition of osteoporosis is a decrease in the amount of calcified bone tissue to the point that fractures occur with minimal trauma. Researchers have shown that peak bone mass at skeletal maturity may be the single most important factor in the development of osteoporosis. At present, no satisfactory way to replace lost bone exists, and the ideal treatment for osteoporosis is prevention, which must begin early in life. The most promising approach in the primary prevention of osteoporosis is to help each person achieve as high a peak skeletal mass and bone density as genetically possible prior to skeletal maturity. Furthermore, identifying those adolescents and young adults at risk is of clinical value for prediction and counseling purposes. Recommendations for achieving the maximal bone mass prior to skeletal maturity, as well as methods of assessing and minimizing the risk factors for osteoporosis, will be discussed.