We assessed the relationship between bone mineral density (BMD) and hormonal cytology in 181 postmenopausal women. BMD was measured by dual energy X-ray absorptiometry (DXA). Age, height, weight, body mass index (BMI), age at menopause, hormonal cytology (eosinophilic index (EI), karyopyknotic index (KPI) and maturation value (MV)) and estradiol were investigated. A positive correlation was found between BMD and hormonal cytology (EI r = 0.17 p < 0.05, KPI r = 0.19 p < 0.05 and MV r = 0.37 p < 0.005). The low BMD group (BMD < 0.8g/cm2 n = 87) had significantly lower hormonal cytology than the normal BMD group (BMD > or = 0.8g/cm2 n = 94). The receiver operating characteristic curve analysis showed MV at 30 was available for the cutoff point in predicting osteopenia. MV < 30 detected osteopenia (BMD < 0.8g/cm2) as 0.76 in sensitivity and 0.65 in specificity. These findings suggest that hormonal cytology is useful for screening osteopenia in post-menopausal women.