<p>Tennis is a high-impact unilateral sport that may enhance bone mineral density (BMD) during growth, although evidence in young players has been limited. This review finds that tennis participation is associated with higher site-specific BMD, with lean body mass (LBM) being the strongest predictor, while training-related associations remain inconsistent. Osteoporosis is defined by compromised bone strength due to reduced bone mass and deterioration of bone microarchitecture, leading to an increased risk of fragility fracture and associated morbidity and mortality. Peak bone mass (PBM) is largely accrued during childhood, adolescence, and young adulthood, making youth a critical period for optimizing bone health. High-impact sports such as tennis may promote osteogenic responses of bone, yet evidence in younger populations remains limited. This narrative review explores findings from 15 studies examining BMD in paediatric, adolescent, and young adult tennis players, identified through a systematic search of PubMed, Google Scholar, and Embase. Across studies, tennis players demonstrated significantly higher BMD compared to controls, particularly in the dominant upper limb, reflecting site-specific adaptations to unilateral loading. LBM was highlighted as the strongest predictor of BMD, while associations with training frequency and strength measures were mixed. Overall, tennis participation during growth appears to be associated with favourable site-specific skeletal adaptations. However, small sample sizes and heterogeneity in study design, participant maturity, and outcome reporting limit generalisability, underscoring the need for further research.</p>