Highlights:• Bone has a complex multi-level hierarchical organisation. This structural organisation is key for its outstanding properties. • Artificial calcium phosphate ceramics (CPCs) are promising for achieving the set of mechanical and biological requirements for use as bone implants. • At individual lengthscales, methods have been developed to control crystal phases, microscale porosity and macroscopic geometry but the CPCs produced remain intrinsically brittle. • Inspired by the organisation of bones and other biomaterials, CPCs and their composites could have their toughness increased through multi-level hierarchical microstructures. • Challenges remain but recent advances in ceramic processing and toughening may pave the way for a new generation of medical implants.