Until recently, much of the research exploring the role of nutrition on bone mass accrual has focused on single nutrients. Although randomised controlled trials have provided key information about the effects of calcium and vitamin D on bone, they also have limitations, e.g. generalisation, implementation of the results and long-term consequences. Human subjects do not eat single nutrients, but foods, and describing healthy food patterns for optimising bone mineral accrual is warranted. Recent advances in research suggest that the effects of whole diet are larger than those of single nutrients on bone health. Research should focus on younger age groups to identify the life-course determinants of osteoporosis during prenatal, infancy, childhood and adolescence that would help to maximise peak bone mass. Food patterns that describe the variability, quality and choices of individuals give broader insight and may provide new strategies for preventing osteoporosis.

Adequate dietary intake during the growth period is critical for bone mineral accretion. In 1997, an adequate intake (AI) of 1300 mg/d Ca was set for North American adolescents aged 9–18 years based on best available data. We determined bone Ca accrual values from age 9 to 18 years taking into account sex and maturity. Furthermore, we used the accrual data to estimate adolescents' Ca requirements. Total body bone mineral content (TBBMC) of eighty-five boys and sixty-seven girls participating in the Saskatchewan Paediatric Bone Mineral Accrual Study were used to determine annual TBBMC accumulation over the pubertal growth period. Using a similar factorial approach as the AI, we estimated Ca requirements of adolescent boys and girls for two age groups: 9–13 and 14–18 years. Between 9 and 18 years, boys accrued 198·8 (sd 74·5) g bone mineral content (BMC) per year, equivalent to 175·4 (sd 65·7) mg Ca per d with the maximum BMC accrual of 335·9 g from age 13 to 14 years. Girls had 138·1 (sd 64·2) g BMC per year, equalling121·8 (sd 56·6) mg Ca per d with the maximum annual BMC accrual of 266·0 g from age 12 to 13 years. Differences were observed between both sex and age groups with respect to Ca needs: boys and girls aged 9–13 years would require 1000–1100 mg/d Ca, and from age 14 to 18 years, the mean Ca requirements would be relatively stable at 1000 mg/d for girls but would rise to 1200 mg/d for boys.