INTRODUCTION: The results of many studies regarding Modic changes with lower back pain (LBP) are controversial. This is because most of these studies have been performed in selected groups of patients. The purpose of this study was to examine the association between Modic changes and LBP in a large population‐based cohort. METHODS: Of the 952 subjects who participated in the second Wakayama Spine Study, 820 subjects (men, 249; women, 571; mean age, 63.3 y) were included in this study. The degree of endplate changes as measured by MRI were classified on the basis of the Modic classification system. The definition of LBP was continuous back pain for at least 48 hours in the past month. The prevalence of Modic change types in the lumbar region was assessed. Multiple logistic regression analysis was conducted to determine the association between types of Modic changes and LBP in comparison to subjects without radiographic changes, after adjusting for age, body mass index, and gender. RESULTS: The prevalence of type 2 Modic changes was highest (type 1, 10.7%; type 2, 31.7%; and type 3, 2.9%). Type 1 Modic changes were significantly associated with LBP (odds ratio (OR) 1.97, 95% confidence interval [CI] 1.2‐3.2, p=0.007); however, type 2 and 3 Modic changes were not significantly associated with LBP (type 2: OR 1.37, 95% CI 0.9‐1.9, p=0.08; type 3: OR 2.39, 95% CI 0.9‐5.72, p=0.05). DISCUSSION: Type 1 Modic changes in the lumbar region are significantly associated with LBP whereas other Modic change types are not. To the best of our knowledge, this is the first large population‐based study on the association between Modic changes and LBP. However, this study is cross‐sectional in design, and therefore, investigations into Modic changes and LBP are ongoing.