The prevalence and the clinical and social importance of osteopenia and osteoporosis are increasing in western societies. To improve knowledge of the risk factors associated with these conditions, we assessed the relationship between bone mass density and plasma lipid profile in a cohort of postmenopausal women. We studied 1303 postmenopausal women who attended a menopause outpatient clinic. All women underwent bone mineral density determination at the level of the lumbar spine. Plasma lipids and lipoproteins and bone metabolic markers were assessed on a blood sample obtained after a 12-hour fast. Statistically significant associations were found by univariate analysis between prevalence of osteopenia and age, time since menopause, body mass index, and low-density lipoprotein (LDL) cholesterol. Specifically, women with plasma LDL cholesterol levels of at least 160 mg/dL had a more than doubled probability of being osteopenic compared with women with lower LDL cholesterol (47.9% versus 21.2%, respectively). Time since menopause, body mass index, and LDL cholesterol were the only variables significantly associated with the prevalence of osteopenia, by multivariable analysis. Postmenopausal women with increased plasma LDL cholesterol levels had a greater probability of being classified as osteopenic than women with normal plasma LDL cholesterol levels. Our data, if confirmed, suggest that elevated levels of plasma LDL cholesterol should be regarded as an additional risk factor for reduced bone mineral density.