PURPOSE: To analyze the bone mineral density (BMD) in multiple myeloma (MM) and to compare BMD with plain radiography, MRI and clinical stage. MATERIALS AND METHODS: We reviewed 59 patients with MM and an age- and sex-matched control group, with measured BMD. The L-spine and femoral neck (FN) BMD were measured by dual-energy X-ray absorptiometry. Lateral plain radiographs of the L-spine were graded as 3 stages using the modified Saville index. Four bone marrow patterns were classified on sagittal T1- and T2-weighted magnetic resonance images of the L-spine. BMD in the MM and control group were analyzed. BMD in MM was compared with the modified Saville index, bone marrow patterns on MRI, and clinical stages. RESULTS: In MM, spine BMD was reduced and the difference between spine and FN BMD was larger than the control group (p < 0.001). The modified Saville index was negatively correlated with spine T scores (p < 0.01). The spine BMD in normal marrow pattern on the MRI was the most reduced. There was no statistical correlation between BMD and clinical stage. CONCLUSION: In MM, spine BMD was significantly reduced and the difference between spine and FN BMD was larger than the control group. The modified Saville index was significantly correlated with spine BMD in MM.