There are a large number of clinical and experimental studies that analyzed trabecular architecture as a result of bone adaptation. However, only a limited amount of quantitative data is currently available on the progress of trabecular adaptation during growth. In this paper, we proposed a two-step numerical simulation method that predicts trabecular adaptation progress during growth using a recently developed topology optimization algorithm, design space optimization (DSO), under the hypothesis that the mechanisms of DSO are functionally equivalent to those of bone adaptation. We applied the proposed scheme to trabecular adaptation simulation in human proximal femur. For the simulation, the full trabecular architecture in human proximal femur was represented by a two-dimensional mu FE model with 50 pin resolution. In Step 1, we determined a reference value that regulates trabecular adaptation in human proximal femur. In Step 2, we Simulated trabecular adaptation in human proximal femur during growth with the reference value derived in Step 1. We analyzed the architectural and mechanical properties of trabecular patterns through iterations. From the comparison with experimental data in the literature, we showed that in the early growth stage trabecular adaptation was achieved mainly by increasing bone volume fraction (or trabecular thickness), while in the later stage of the development the trabecular architecture gained higher structural efficiency by increasing structural anisotropy with a relatively low level of bone volume fraction (or trabecular thickness). We demonstrated that the proposed numerical framework predicted the growing progress of trabecular bone that has a close correlation with experimental data. (C) 2009 Elsevier Ltd. All rights reserved.