Objective: To investigate the relationship between body fat distribution and bone mineral density (BMD). Methods: Subjects were 282 premenopausal women (mean age ± standard deviation [SD], 38.8 ± 8.5 years; range, 20–51 years) with regular menstrual cycles. Baseline characteristics included age, age at menarche, height, weight, body mass index ([BMI], weight/height2), and parity. Anthropometric characteristics including the ratio of trunk fat mass to leg fat mass (trunk–leg fat ratio), percentage of body fat, and total body lean mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Lumbar spine BMD (L2–4) was also measured by dual-energy x-ray absorptiometry. Correlations of BMD to baseline and anthropometric characteristics were investigated using univariate and multivariate analysis. Results: Although height, trunk–leg fat ratio, and total body lean mass were positively correlated with lumbar spine BMD (r = .18, P < .01; r = .17, P < .01; and r = .25, P < .001; respectively), age at menarche was inversely correlated with BMD (r = −.19, P < .01). On multivariable analysis, trunk–leg fat ratio, height, age at menarche, and total body lean mass were still independently correlated with lumbar spine BMD (P < .05). However, total fat mass was not correlated with BMD. Conclusion: Upper body fat distribution rather than overall adiposity is associated with lumbar spine BMD in premenopausal women. Humoral factors associated with body fat mass appear to influence lumbar spine BMD.