Routine CT Scans Could Help Screen for Both Osteoporosis and Heart Disease, Study Finds

A new study led by UCLA professor and Bone Density Inc. chief medical officer Dr. Matthew Budoff suggests that routine CT scans could be used to screen patients for both osteoporosis and coronary artery disease, potentially closing significant gaps in preventive care.

The research proposes that already-completed CT exams, such as those performed for other diagnostic reasons, could be repurposed to measure bone mineral density (BMD) and coronary artery calcium (CAC)—key indicators of bone health and cardiovascular risk, respectively.

“These metabolic conditions are prevalent in middle age and older adults and can have severe consequences if—as often happens—they go undetected and thus untreated,” said Budoff. “Getting new imaging or other testing for each such disease is expensive and burdensome—hence this at-risk population often goes untested. This study shows that now we can detect and stratify the risk of multiple significant metabolic diseases like these in the same ‘opportunistic’ screening of an existing patient CT scan.”

The team analyzed data from more than 6,800 adults aged 45 to 84 who were initially free of cardiovascular disease and enrolled in the NIH’s Multi-Ethnic Study of Atherosclerosis (MESA). Using Bone Density Inc.’s proprietary algorithms, researchers evaluated bone density from CT scans to identify cases of osteopenia and osteoporosis, while also measuring CAC scores as indicators of heart disease risk.

Results revealed a strong inverse relationship between bone density and coronary calcium levels. Specifically, participants with lower bone mineral density were significantly more likely to have higher CAC scores. For example, individuals with a CAC score above 300 had an average bone mineral density reduction of 7 mg/cc in men and 5 mg/cc in women.

Men with osteoporosis were found to have a 65% higher likelihood of elevated CAC, while women with osteoporosis had a 32% increased likelihood. These findings suggest that a single CT scan could effectively stratify a patient’s risk for both fractures and cardiovascular events.

The implications for clinical practice could be substantial. Because osteoporosis screenings are already widely reimbursed by insurance providers, radiologists could use the same scans to also flag cardiovascular risk—even though CAC screening itself is not yet routinely covered.

“[Coronary artery calcium] is a well-known indicator of heart attack and stroke risk, but payers do not widely cover screening for CAC,” said Jonathan Taub, CEO of Bone Density Inc. “Because BDI’s osteoporosis screening is widely covered by payers, our same osteoporosis screening can determine [cardiovascular disease] risk that may otherwise go undetected (and thus untreated) until ‘too late’—after adverse outcomes like heart attacks and strokes.”

The researchers are hopeful that this dual-purpose use of routine imaging could prompt a shift in clinical protocols and reimbursement models, paving the way for more cost-effective, proactive, and comprehensive screening strategiesfor aging adults.