Summary <p>According to the multivariable adjusted models, there was an inverse association between B-Cd levels and BMD, which was particularly evident in the subgroup analyses of other Hispanic and female individuals in the adolescent population. Clinicians and policy-makers should thoroughly consider the genetic implications of B-Cd levels in relation to BMD during the prevention and treatment of osteoporosis.</p> Objective <p>To investigate the associations between blood cadmium (B-Cd) levels and bone mineral density (BMD) in adolescents.</p> Methods <p>On the basis of the National Health and Nutrition Examination Survey (NHANES) database spanning from 2011 to 2018, we used weighted multiple regression, a generalized weighted model and smoothed curve methods to investigate the associations between B-Cd levels and BMD in adolescents. Subgroup analyses were also conducted to examine potential differences across age, sex, race, tobacco exposure status and other relevant variables.</p> Results <p>Among the 2427 participants, 52% were males, and 48% were females. In this study, multistage sampling data from the NHANES database were analysed, and the positive association between B-Cd levels and BMD shifted to a negative association after adjustment for age, sex and race. Subgroup analyses revealed a more pronounced association among females (<i>β</i> =  − 0.07, 95% CI: − 0.09, − 0.04, <i>P</i> &lt; 0.001), other Hispanic individuals (<i>β</i> =  − 0.08, 95% CI: − 0.14, − 0.02, <i>P</i> = 0.012) and individuals exposed to tobacco (<i>β</i> =  − 0.04, 95% CI: − 0.06, − 0.01, <i>P</i> = 0.016).</p> Conclusion <p>The findings revealed a negative association between B-Cd levels and BMD in multivariable adjusted models.</p>