The relationship of fractures to physical activity and growth velocity in stature and metacarpal II bone dimensions was investigated in adolescent Belgian boys. Peak fracture incidence occurred between 12 and 14 yr of age and preceded the age at peak height velocity. The peak fracture rate occurred during mid adolescence (+/- 2 SD of the age at peak height velocity) and was twice as high as the rates before and after this period. The majority of fractures occurred during active participation in sports and general physical activities. The age at peak growth velocity for metacarpal cortical thickness, an indirect measure of bone mineral content, was about 6 months later than the ages at peak height velocity and peak growth velocity for metacarpal length. Peak fracture incidence occurred during a period when the amount of time spent in sports physical activity was low compared with later years. A lag in cortical bone thickness and mineralization, relative to linear skeletal growth, and unknown factors associated with active participation in sports, rather than an increase in the amount of physical activity, appear to be the predominant factors associated with the increased fracture incidence in Belgian boys during the growth spurt.