The possibilities of utilizing nacre as a reinforcing material to manufacture 3D printed bone grafts are yet to be explored. This work reports the feasibility of fabricating 3D printed nacre-hydroxyapatitestarch composite bone graft substitutes, emphasizing the effects of nacre addition on biological and mechanical properties. Pressure-less extrusion-based 3D printing of ceramic-polymer viscous slurry is challenging due to the composition and process-parameter variations. To overcome these challenges, a dual extrusion solid freeform fabricator (SFF) has been designed. An increase in nacre loading improves the compressive strength from 9.5 ± 0.1 MPa to 11.7 ± 0.2 MPa, without any post-processing or sintering. Nacre's in vitro osteogenic properties lead to a slight increase in hFOB cellular attachment on the graft surface by day 11. The fabricated structures show good mechanical integrity during the dissolution study in simulated body fluid (SBF). These bone graft substitutes may be utilized to repair low load bearing skeletal defects.