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Objective To explore the correlation between trunk muscle index and osteoporotic vertebral fracture (OVF) in postmenopausal women, and to provide new ideas for the prevention and treatment of osteoporotic fracture. Methods A total of 424 postmenopausal women were included, including 212 cases of OVF and 212 cases of osteoporosis (without OVF). Clinical factors were evaluated and bone mineral density, limb and trunk muscle mass were measured. Multiple logistic regression was used to analyze the correlation between trunk muscle index and OVF. Results The trunk muscle mass and trunk muscle index of women with OVF were lower than those without OVF (15.99 ± 2.04 vs. 16.72 ± 2.22; 6.76 ± 0.72 vs. 7.09 ± 0.85). After adjusting for traditional risk factors of osteoporosis, trunk muscle index was positively correlated with lumbar BMD (r=0.186, P<0.001), and trunk muscle index was a protective factor for OVF (P=0.037, OR=0.684, 95% CI: 0.478-0.978). Based on the trunk muscle index, the prevalence of OVF decreased significantly in the four quartiles. Conclusion Trunk muscle index is closely related to lumbar bone mineral density and OVF in postmenopausal women in Kunshan area. Maintaining a high level of trunk muscle index may help to reduce the occurrence of OVF. The correlation between trunk muscle index and lumbar bone mineral density and OVF suggests the internal relationship between the muscle and the bone. [ABSTRACT FROM AUTHOR]