Peak bone mass accrual occurs during adolescence. We observed an increased fracture rate in children and adolescents in Western Australia that potentially indicates poor bone health. Optimization of bone health in childhood is important not only for prevention of fractures in childhood but also for reducing the risk of osteoporosis later in life and thus has substantial public health and health economic benefits. The current strategy to prevent osteoporosis in Australia emphasizes the importance of maximizing peak bone mass accrual during adolescence. Peak bone mass is achieved by bone accretion throughout childhood and adolescence and is completed in early adult life. Recommendations include optimising vitamin D status and calcium supplies, sun exposure and exercise. Mechanical loading from physical activity is essential to stimulate bone modelling. Based on positive experience in adolescents with coordination disorder we are discussing the potential benefit of targeted exercise programs on bone health in youth.