Estrogens are involved in accretion of bone mass during puberty. Catechol-O-Methyltransferase (COMT) is involved in the degradation of estrogens. In this cross-sectional study we investigated associations between the COMT val158met polymorphism, which results in a 60 -75% difference in enzyme activity between the val (high activity ϭ H) and the met (low activity ϭ L) variant, and skeletal phenotypes in 246 healthy pre/early pubertal girls. Girls with COMT LL were 5.4 cm taller than COMT HH girls. Dual x-ray absorptiometry showed higher values of bone mineral content (BMC), and larger areas of total body, femur and spine in COMT LL . Cortical BMC, measured by peripheral quantitative computerized tomography in the tibia, was 9.8% higher in COMT LL compared with COMT HH . This was due to a larger cortical cross sectional area while the cortical volumetric bone mineral density was not associated with COMT genotype. COMT LL girls had higher serum levels of free estradiol and insulin like growth factor. Regression models indicated that COMT genotype exerted effects on skeletal growth mainly via a regulation of free estradiol, resulting in an affected pubertal development (Tanner staging). We propose that the COMT LL genotype results in higher free estradiol levels and earlier pubertal development, leading to an increased skeletal growth in pre/early pubertal girls. Peak bone mineral density (BMD) is an important determinant of the risk of developing osteoporosis later in life (1,2). It is generally well accepted that about 70% of the variation in peak BMD is due to genetic differences (3,4). Several different hormones, growth factors and nutritional factors are involved in the regulation of the accretion of bone mass (5,6). During childhood, thyroid hormones and the GH/IGF-axis are the principal hormones controlling growth (7-9). The following pubertal growth period is crucial for bone accretion, with past