Vertebral Bone Mineral Density Measured on Coronary CT Angiography as a Marker of Coronary Artery Disease Severity

Osteoporosis and atherosclerosis are prevalent diseases that exert significant impacts on morbidity and mortality.

To investigate the relationship between opportunistically measured thoracic vertebral bone mineral density (BMD) on coronary computed tomography angiography (CCTA) and coronary artery disease (CAD), coronary artery stenosis severity and coronary artery calcium score (CACS).

This retrospective study included 386 patients undergoing CCTA for suspected CAD. BMD was measured on non-contrast images using Hounsfield units (HU), and values < 200 HU were defined as low BMD. Coronary artery stenosis, vessel involvement and CACS were evaluated. Logistic and linear regression analyses were performed to assess associations between BMD, CAD and CACS.

Among 386 patients (55.7% male, mean age 51.5 ± 11.4 years), CAD was detected in 49 (12.7%). Low BMD was significantly more frequent in patients with CAD and was independently associated with its presence (OR = 2.98, p = 0.003). The prevalence of coronary artery stenosis was significantly higher in the low BMD group, including LMCA (10.9% vs. 1.9%), LAD (45.0% vs. 20.4%), RCA (27.9% vs. 12.1%) and Cx (20.1% vs. 10.8%) (p < 0.05 for all). Moderate and severe CACS were also more common in patients with low BMD (p < 0.001). BMD showed a significant negative association with CACS.

Lower thoracic vertebral BMD is independently associated with the presence and severity of CAD and higher coronary calcium burden. Opportunistic BMD assessment on routine CCTA may serve as a complementary imaging biomarker reflecting overall cardiometabolic risk.