Pediatric and adolescent care professionals have increasingly recognized the importance of understanding the skeletal health of their patients. Peak bone mass, the "bone bank" on which an individual will draw for their entire adult life, is likely achieved by late adolescence, with the critical window for accumulation occurring much earlier. This review outlines the known conditions that are associated with impaired bone mineral accrual and clinical settings in which the evaluation of "at-risk" adolescents should be considered. We describe the methods available to the health care professional for evaluating bone density, along with the limitations of each technology. Potential therapeutic options for patients identified to have a low bone mineral density are discussed. Finally, current recommendations regarding physical activity and nutrition, beneficial interventions for all adolescents, are presented.