Abstract: Objective: To investigate the relationship between epicardial adipose tissue(EAT) volume and Lumbar bone mineral density(BMD). Methods: In this study, we retrospectively analyzed non-contrast CT images and QCT images from 600 patients. Subjects were grouped according to BMD. The EAT was extracted from the chest CT images of the admitted patient and the volume was calculated. The difference of EAT volume was detected by one-way analysis of variance. The correlation between BMD and EAT was tested by Pearson Correlation Coefficient. A two-sided P<0.05 was considered significant. Results: There was a significant difference in the volume of EAT among the normal group, osteopenia group and osteoporosis group(F=65.80, P<0.001), and there was a negative correlation between the volume of epicardial fat and BMD(r=-0.805 95% CI:-0.858,-0.745). The area under the curve of BMD, the volume of epicardial fat and the clinical mixed model were 0.80(95% CI:0.75 ~ 0.83), 0.75(95% CI:0.72 ~ 0.81) and 0.88(95% CI:0.81 ~ 0.94), respectively. The clinical benefit thresholds of lumbar BMD, epicardial fat volume and clinical mixed model were 0.02 ~ 0.89, 0.05 ~ 0.82 and 0.01 ~ 0.98, respectively. Conclusion: The volume of EAT is closely related to the BMD of lumbar spine. The volume of EAT might be used as a potential biomarker to evaluate the BMD of lumbar spine. The diagnosis model based on clinical factors has a good prediction effect on low back pain in physical examination population.