Objective To find an optimized bone mineral density (BMD) detection strategy for clinical preliminary osteoporosis diagnosis on the premise of ensuring the diagnostic efficiency and reliability.Methods A total of 1480 adult subjects were recruited. The BMD of these participants was detected by dualenergy X-ray absorptiometry (DXA) in the lumbar spine orthotopic positions 1-4 (L) and the left and right hip (LH and RH). Results The diagnostic efficiency of combined 3-ites (L+LH+RH) BMD was slightly higher than that of L+RH or L+LH BMD (P＜0.05), and the likelihood of missed diagnosis was lower than 5% with combined 2sites (L+LH and L+RH) BMD detection. If the diagnostic efficiency of combined 3sites Tscores served as the standard, the diagnostic accordance rate of L+LH BMD was the highest (96.76%), and that of L (76.93%) was higher than that of LH (66.53%) and RH (64.94%) in all subjects. Considering the sex and age factors, the diagnostic accordance rate of L+LH (91.84%-99.40%) BMD was the highest in both 2-and 1site BMD detections of most postmenopausal females and males over 50 years old. The diagnostic accordance rate of L (63.27%-90.97%) was higher than the only other 1-site BMD in most postmenopausal females and males 50-59 years old. Conclusion Our results suggest L+LH as the first option for BMD measurements, and L was also valuable under limited conditions. In addition, our thermograph of diagnostic efficiency in different BMD detection sites might be useful for the individual diagnosis of osteoporosis.