Objective <p>To compare the performance of T-score, HU values, and VBQ scores in assessing bone mineral density in patients with degenerative lumbar scoliosis (DLS).</p> Methods <p>A total of 320 patients were retrospectively reviewed, including 220 with DLS and 100 age-matched patients with lumbar spinal stenosis as the control group. The DLS cohort was stratified into three subgroups based on Cobb angle: mild scoliosis group(10° &lt; Cobb angle ≤ 20°), moderate scoliosis group(20° &lt; Cobb angle ≤ 40°) and severe scoliosis group(Cobb angle &gt; 40°). Osteopenia and osteoporosis thresholds for HU values and VBQ scores were determined via Receiver Operating Characteristic (ROC) analysis in the control group and applied to the DLS group. Demographics, clinical data, T-score, HU values and VBQ scores were compared between groups. Pearson correlation analysis was performed among HU values, VBQ scores, and T-score (L1-4).</p> Results <p>Demographics, clinical data and T-score (L1-4) showed no significant differences between the DLS and control group. DLS patients had significantly lower Lowest Hips T-score and HU values but higher VBQ scores than the control group. HU values were significantly lower in moderate and severe scoliosis subgroup compared to the mild scoliosis subgroup (<i>p</i> &lt; 0.05). In the DLS group, T-score (L1-4) correlated positively with HU values, and the correlation coefficients in mild scoliosis subgroup were higher than those in moderate and severe scoliosis subgroup. Based on HU values, the incidence of undiagnosed osteoporosis in the severe scoliosis subgroup was significantly higher than that in the mild and moderate subgroup (54.5% vs. 31.2% &amp; 18.2%).</p> Conclusion <p>Patients with DLS can present with aberrantly increased T-score evaluated by DXA, whereas HU values and VBQ scores provide more accurate BMD assessments. Furthermore, HU values are superior to VBQ scores in the accuracy of diagnosing osteoporosis, particularly in patients with severe scoliosis.</p>