Abstract: The pathological process of osteoporosis can be traced back to childhood and adolescence. This period represents a critical window for bone development, during which approximately 40% to 60% of adult bone mass is accumulated. Increased peak bone mass significantly delays the onset of osteoporosis. However, challenges such as fragmented research approaches and delayed interventions have hindered systematic intervention during this window. This article systematically outlines comprehensive lifecycle management of bone health in children and adolescents from 4 perspectives—epidemiology, regulatory mechanisms, influencing factors, and prevention and control strategies. Currently, inadequate calcium intake, vitamin D deficiency, and insufficient physical activity are common problems among children and adolescents in China, with regional bone density data exhibiting significant disparities by urban or rural and sex. Bone development is regulated through the synergistic effects of multiple factors, including endocrine systems, genetics, mechanical stress, and gut microbiota. Based on the "three-tier prevention" framework, primary prevention focuses on nutritional and physical activity interventions, secondary prevention involves the screening of high-risk populations, and tertiary prevention is limited to pharmacological treatment of severe bone disorders. Early-life intervention should be prioritized as a public health strategy to establish a robust defense system for lifelong bone health.