The circulating level of creatinine is a direct, stable indicator of skeletal muscle mass. However, evidence regarding the correlation between serum creatinine (SCre) and bone health is limited. This study aimed to evaluate the association between SCre level within the normal range and bone mineral density (BMD) in adolescents.

We analyzed data for 3,395 adolescents aged 12–19 years from the National Health and Nutrition Examination Survey (2011–2018). Weighted multiple linear regression was conducted to assess the association between SCre and BMD. Weighted generalized additive models and smooth curve fittings were used to address nonlinearity.

After controlling for potential confounding factors, we found that higher SCre levels were associated with higher total BMD and lumbar BMD in adolescents. This association remained positive in the subgroup analyses stratified by age, gender, or race. Furthermore, the positive association was more prominent in adolescent boys than adolescent girls aged 12–15 years.

Our findings indicated that higher SCre levels within the normal range in adolescents aged 12–19 years were associated with higher BMD, suggesting that SCre may be a potential biomarker for bone health in adolescents.