New NIH-Funded Study Links Low Bone Density to Elevated Heart Disease Risk, Opening Door to Dual Prevention with One CT Scan Test
A new study presented at the 2025 Endocrine Summit of the Clinical Association of California Endocrinologists has shed fresh light on the critical link between two seemingly distinct health conditions—osteoporosis and cardiovascular disease (CVD). The findings, led by UCLA Professor of Medicine and BDI Chief Medical Officer Dr. Matthew Budoff, MD, suggest that screening patients for low bone mineral density (BMD) not only uncovers osteoporosis risk but can also reveal hidden cardiovascular disease risk.
This breakthrough builds on years of research showing the inverse relationship between bone density and coronary artery calcium (CAC)—a biomarker widely recognized as a predictor of heart attack and stroke. With support from the National Institutes of Health (NIH), the new long-term longitudinal study stratifies this association more clearly than ever, mapping specific levels of bone loss to corresponding levels of elevated CAC. The result is a more nuanced framework for prevention, enabling clinicians to deliver more personalized care for both osteoporosis and heart disease risk—using a single opportunistic test from existing patient CT scans.
The Bone-Heart Connection
For decades, osteoporosis and cardiovascular disease have been studied separately. Osteoporosis is typically regarded as a musculoskeletal-metabolic condition, while coronary artery calcium accumulation is considered a cardio-metabolic disorder. However, mounting evidence indicates the two are interlinked. Low BMD—whether mild osteopenia or more severe osteoporosis—has been consistently associated with elevated CAC and higher risk of cardiovascular disease events.
The latest NIH-funded study provides some of the strongest confirmation yet of this connection. By stratifying bone density levels against CAC scores, researchers demonstrated that individuals with lower BMD also carried higher and clinically significant risks of elevated coronary calcium. This relationship was particularly strong in patients who had not yet been diagnosed with overt cardiovascular disease, suggesting that bone density testing could serve as a powerful early-warning system.
“This study shows the strong interconnection of metabolic diseases—even seemingly different MSK-metabolic and cardio-metabolic conditions such as low bone density and elevated cardiovascular risk,” explained Dr. Budoff. “Both conditions are highly prevalent in middle age and older adults, and both can have devastating consequences if they go undetected and untreated. The fact that we can now detect and stratify risk for both conditions using the same CT scan provides a major advance in preventative care.”
The NIH’s Multi-Ethnic Study of Atherosclerosis (MESA)
The findings emerged from the Multi-Ethnic Study of Atherosclerosis (MESA), a landmark prospective cohort study funded by the NIH. MESA followed 6,814 men and women between the ages of 45 and 84 who were free of clinical cardiovascular disease at baseline. Importantly, this demographic overlaps significantly with the population typically screened for osteoporosis, strengthening the real-world applicability of the results.
Researchers found a two-way relationship between elevated CAC and osteoporosis. Not only was low BMD associated with higher CAC, but patients with elevated CAC were also more likely to show lower bone density. Since the study excluded participants with diagnosed cardiovascular disease, the findings highlight the potential of bone density screening to uncover hidden heart disease risk before it manifests in clinical symptoms.
“This means the same BDI bone mineral density test for osteoporosis can also detect hidden cardiovascular disease risk,” Dr. Budoff said. “And because we can stratify this risk—showing gradations of likelihood based on BMD levels—we now have a tool to better tailor preventative strategies for both heart disease and osteoporosis.”
Numbers that Matter: Stratifying Risk
The study provides quantifiable thresholds linking bone density and CAC. A prior BDI-led study published in The Journal of the American College of Cardiology (JACC, May 2023) identified CAC >300 as a highly significant threshold for elevated cardiovascular risk. In the latest research, the team found that men with CAC >300 had, on average, 7 mg/cc lower BMD than men with normal CAC scores. Women with CAC >300 showed a 5 mg/cc reduction in BMD compared to their normal counterparts.
More strikingly, the study revealed that men diagnosed with osteoporosis by BDI’s CT-based bone density test had a 65% increased likelihood of having a CAC score above 100. Men with osteopenia (defined by a T-score between -1 and -2.5) carried a 29% increased risk of CAC >100. In women, osteoporosis was associated with a 24% increased likelihood of having a CAC score between 1 and 100, and a 32% increased likelihood of CAC above 100.
These stratifications are not just academic—they directly inform clinical decisions. Providers can use this data to determine whether patients with low BMD should undergo preventative cardiovascular interventions such as lifestyle changes, medication, or closer monitoring. Similarly, patients flagged for elevated CAC risk could be counseled on bone health strategies to mitigate osteoporosis risk.
The Case for Opportunistic Screening
One of the most significant advantages of this approach is cost-effectiveness. Traditional screening for CAC is not widely covered by insurers, despite being one of the most validated predictors of cardiovascular events. In contrast, osteoporosis screening—particularly using CT scans of existing patients—is already widely reimbursed.
By layering CAC risk detection into osteoporosis screening, BDI has effectively turned one reimbursed test into a dual-purpose tool that benefits both patients and payers.
“CAC 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 BDI. “Because BDI’s osteoporosis screening is widely covered, our test can simultaneously determine cardiovascular risk that would otherwise go undetected until it is too late—after adverse events like heart attacks or strokes. With one screening, we can help prevent both osteoporotic fractures and cardiovascular outcomes.”
Implications for Clinical Practice
The clinical implications of the study are profound. Currently, osteoporosis and cardiovascular disease are managed in separate silos. An older adult may receive bone density testing through a rheumatologist or endocrinologist, while cardiovascular risk assessments occur through cardiologists or primary care. Rarely are the two considered together.
With BDI’s opportunistic screening method, a patient undergoing a CT scan—for any reason—can be evaluated for both BMD and CAC. This approach leverages existing imaging without additional scanning, radiation, or patient burden. It also makes screening more accessible by embedding it into routine care.
For providers, this means more comprehensive risk profiles with no added logistical complexity. For patients, it means earlier detection and intervention—potentially preventing both fractures and cardiovascular events. And for the healthcare system, it means greater efficiency, with one reimbursed test serving multiple prevention pathways.
A New Era of Integrated Preventive Medicine
The new findings reinforce the idea that metabolic diseases, even when they appear distinct, are deeply interconnected. Osteoporosis and cardiovascular disease share overlapping risk factors—age, hormonal changes, inflammation, and lifestyle behaviors such as smoking and diet. By recognizing and acting on these connections, clinicians can move closer to truly personalized medicine.
“This is about prevention, not reaction,” said Dr. Budoff. “Too often, patients are only diagnosed after they suffer a fracture, a heart attack, or a stroke. By then, the consequences are severe and costly. Opportunistic CT screening allows us to detect risk factors early, when prevention is possible, safe, and far less expensive.”
The study also underscores the value of large-scale, longitudinal NIH research like MESA, which provides robust datasets to uncover new clinical insights. And it highlights the role of innovative diagnostic companies like BDI in translating research into practical, reimbursed solutions that can be deployed at scale.
