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Osteoporosis and fragility fracture is largely preventable. Impressive research and policy efforts now contribute to the promotion of optimal bone health during the growing years. There is also an increasing uptake of older people into bone health programs but the gap is unbridled, for there is, yet, no current evidence of concerted efforts towards the application of clearly defined, easily adaptable and widespread intervention for promoting bone health among the premenopausal age-groups. Since contemporary public health underscores population-applicable, lifestyle approaches to health promotion and disease prevention, this review puts into both physiological and public health perspectives, current guidelines for prevention of osteoporosis and suggests a paradigm change towards the appropriate consideration of primary prevention of osteoporosis in the population.