Background: Lead exposure continues to be an important issue for human health. Previous studies indicated that lead may directly affect osteoblast and osteoclast function, and indirectly influence bone turnover due to kidney dysfunction. Some animal research also demonstrated that lead exposure was associated with decreasing bone mineral density. However, the evidence from the human study is lacking. Aims: Our objective is to investigate the association between lead exposure and adult bone health. Methods: Participants' data (n=439) were drawn from the Nutrition and Health Survey in Taiwan (NAHSIT) for 2005-2008. It was a national survey with high representativeness in Taiwan. Bone health was divided into normal (T-score > -1), osteopenia (T-score between -1 and -2.5) or osteoporosis (T-score < -2.5). We used inductively coupled plasma mass spectrometry (ICP-MS) to analyze urinary cadmium and urinary lead levels. Every participant completed the questionnaire including their education, household income, smoking status, alcohol consumption, diet supplement consumption, and outdoor activity. Results: In multivariable logistic regression, increasing age (OR = 1.07; 95% CI = 1.04-1.10; p < 0.001), former smoker (OR = 2.99; 95% CI = 1.20-7.44; p = 0.01) and high urinary lead level (OR = 1.98; 95% CI = 1.00-3.90; p = 0.04) were found to be associated with osteopenia or osteoporosis. After further stratification by gender, increasing age still associated with osteopenia or osteoporosis in both men and women. High urinary lead level was observed to increase risk of osteopenia or osteoporosis in women (OR = 2.66; 95% CI = 1.01-7.06; p = 0.04), but not in men. Conclusions: The results suggest that women with high urinary lead level have higher risk of osteopenia or osteoporosis.