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The purpose of this study was to determine the utility of dual-energy X-ray absorptiometry (DXA)-derived fat mass indices for predicting blood lipid profile in postmenopausal women. A secondary purpose was to determine whether waist circumference is comparable with DXA-derived measurements in predicting blood lipid profile. Subjects were 423 postmenopausal women (age 58.1 ± 6.3 years). Fat mass was assessed at abdomen, trunk, and total body using DXA. Anthropometric measurements included BMI and waist circumference. Blood samples were analyzed for total cholesterol (TC), triglyceride (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and cholesterol/HDL ratio. Of the DXA-derived measures, abdominal-fat mass was the best predictor of blood lipid profiles. DXA-derived abdominal fat mass and waist girth explained 20 and 16.5% of variation in TC/HDL ratio, respectively, in univariate analysis, with no difference between the slopes of the regression coefficients. Eighty-four percent of subjects were common to the top quartiles of waist circumference and abdominal fat mass, and blood lipid profiles generally worsened across increasing quartiles. DXA-derived abdominal fat mass and waist circumference are of equivalent utility for predicting alterations in blood lipids. Waist circumference is, therefore, ideal as an inexpensive means in primary health-care services for predicting risk of cardiovascular diseases in postmenopausal women.