The primary objective of the present study was to evaluate the impact of physical activity and muscle strength on bone mineral density (BMD) of the tuberositas tibiae in adolescent boys. Two groups with different exercise levels were compared. The high activity group consisted of 20 subjects (age 15.9 +/- 0.3) from a junior ice hockey team. The reference group consisted of 24 volunteers (age 15.9 +/- 0.3) not training for more than 3 hours per week. The groups were matched for age, weight, and pubertal stage. BMDs (g/cm2) of the tuberositas tibiae and proximal tibia were measured using dual energy X-ray absorptiometry. Quadriceps strength was significantly higher in the high activity group (P < 0.01). Univariate correlations were measured between tuberositas tibiae BMD and pubertal stage, weight, height, BMI, fat mass, lean body mass, quadriceps strength, and hamstrings strength in the high activity group and the reference group, respectively. Quadriceps strength was estimated to be the best significant predictor of BMD of the tuberositas tibiae in the reference group. A multivariate analysis confirmed this result. In the high activity group, there was no significant predictor of BMD of the tuberositas tibiae. There was no significant difference in BMD at this site when comparing the two groups. However, five of the boys in the high activity group had a former history of Mb Osgood-Schlatter with a significantly lower BMD of the tuberositas tibiae than the rest of the boys in that group. After exclusion of these boys, the remaining 15 boys were matched against 20 boys from the reference group using the previous criteria. These 15 boys then showed a significantly higher BMD of the tuberositas tibiae (P < 0.05) but not of the proximal tibia than the 20 boys in the reference group. In conclusion, this study demonstrates site-specific increments of tuberositas tibiae BMD in adolescent ice hockey players unless they are affected by the negative effects on BMD by Mb Osgood-Schlatter. These increments seem primarily to be associated with forceful muscle contractions related to high quadriceps strength and not greater weight-bearing loading. Muscle strength seems to positively affect BMD of the tuberositas tibiae in adolescents, but only up to a certain level, above which additional muscle strength has no effect.