Sept. 29, 2025 — Many studies have shown the inverse relationship between bone mineral density (BMD) — the gold standard measure for osteopenia/osteoporosis and coronary calcium (CAC) — a biomarker of heart attack and stroke risk. For example, mild (osteopenia) or more severe (osteoporosis) low BMD is associated with elevated CAC/cardiovascular disease (CVD) risk. A new NIH-funded long term longitudinal study stratifies this association — showing different levels of low BMD corresponding to different levels of elevated CAC. This enables better, more personalized preventative care for both CVD and osteoporosis. The study was recently presented at the Clinical Association of California Endocrinologists 2025 Endocrine Summit by UCLA Professor of Medicine and BDI Chief Medical Officer Dr. Matthew Budoff, MD.
Dr. Budoff and the BDI team worked with NIH's Multi-Ethnic Study of Atherosclerosis (MESA) — a large prospective cohort study of 6,814 men and women between ages 45 to 84 years (roughly the same as the osteoporosis screening population) free of clinical CVD. The team found a significant two-way relationship between elevated CAC and osteoporosis. Because the MESA study includes only men and women free of clinical CVD, this means the same BDI BMD test for osteoporosis can detect hidden CVD risk and gradations thereof — enabling prevention of fractures, heart attack and stroke with one test.
“This study shows the strong interconnection of metabolic diseases – even seemingly different MSK-metabolic and cardio-metabolic conditions such as low bone density/osteoporosis and elevated CAC/CVD risk. 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. 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. Such ‘opportunistic’ CT screening significantly pioneered by BDI allows us to detect these previously undetected metabolic diseases at once - inexpensively, safely and effectively – enabling better prevention,” explained Dr. Budoff.
A team including BDI previously determined the most significant threshold of elevated CAC is >300 (JACC May 2023). In this most recent study, the BDI team found that CAC >300 corresponds to 7 mg/cc lower BMD than normal in men and 5 mg/cc lower BMD than normal in women. Furthermore, men with osteoporosis determined by BDI’s CT BMD test had a 65% significant increased risk of a CAC score of 100 or greater, and men with osteopenia (T Score of -1 to -2.5 by BDI CT test) revealed a 29% increased risk of having a CAC greater than 100. Women with osteoporosis (T score <-2.5) had a 24% increased likelihood of CAC score of 1-100, and a 32% increased likelihood of CAC greater than 100.
By stratifying CVD risk as such, providers can administer preventative CVD treatment and/or monitor patients if/as appropriate - helping avert heart attacks and strokes in those patients.
“CAC is a well-known indicator of heart attack and stroke risk, but payers do not widely cover screening for CAC,” said BDI CEO Jonathan Taub. “Because BDI’s osteoporosis screening is widely covered by payers, our same osteoporosis screening can determine CVD risk that may otherwise go undetected (and thus untreated) until ‘too late’ – after adverse outcomes like heart attacks and strokes. We are delighted to help prevent these CVD outcomes and osteoporotic fractures with our same BDI osteoporosis screening of existing CT scans.”
Go to https://bdi.ai/ for more information.
November 25, 2025 
