Menopause is a universal physiological process of women's midlife exhibiting a wide variety of symptoms in a different population. Limited studies have examined the association of menopause symptoms with respect to body mass index (BMI) and osteoporosis among rural Indian women. The aim of the present cross-sectional study is an attempt to assess the association of menopause symptoms with body mass index and osteoporosis among rural women of Kanpur, North India. A total sample of 351 women ranging in age between 35 to 55 years was randomly selected from six villages of Kanpur (North India). Menopausal symptoms were measured by using the Greene Climacteric scale. T-score of each subject was gauged from the calcaneus by employing ultrasound based bone densitometer. In anthropometric measurements, height and weight were taken and body mass index (BMI = weight/height(2) kg/m(2)) was calculated. The results indicated that women with psychological (20.8 vs 19.8,p < 0.05), anxiety (21.0 vs 19.5, p < 0.01), and vasomotor (21.6 vs 20.0, p < 0.001) symptoms had a significantly higher mean value of body mass index than their asymptomatic counterparts. The mean value of T scores in the women with psychological (-2.36 vs -1.97, p < 0.05), anxiety (-2.36 vs -2.09, p < 0.05), depression (-2.38 vs -1.97,p < 0.01), somatic (-2.45 vs -1.86,p < 0.001), vasomotor (-2.49 vs -2.15, p < 0.01) and loss of interest in sex (-2.43 vs -1.76, p < 0.001) symptoms was significantly lower than their counterparts with no symptoms. Binary logistic regression analysis confirmed that women with menopausal symptoms had a two-fold higher risk of developing osteoporosis than asymptomatic women. A positive and significant correlation of body mass index was noted with psychological, anxiety and vasomotor symptoms, whereas T-score had a significant association with all the menopausal symptoms.