Lower deep learning-derived thoracic vertebral bone mineral density from noncontrast chest CT was associated with modestly accelerated regional white matter injury and faster cognitive decline, particularly among participants with diabetes, suggesting utility for detecting accelerated brain aging.
Lower baseline vertebral BMD was associated with faster decline in total white matter fractional anisotropy, though this did not survive false discovery rate correction.
Lower baseline vertebral BMD was associated with faster fractional anisotropy decline in the anterior limb of the internal capsule at a regionally specific level that survived false discovery rate correction.
Lower baseline vertebral BMD was associated with faster white matter hyperintensity accumulation in the corpus callosum.
Lower baseline vertebral BMD was associated with faster decline in the global cognitive composite score.
Lower baseline vertebral BMD was associated with faster decline on the Cognitive Abilities Screening Instrument.
Diabetes amplified the association between lower vertebral BMD and white matter hyperintensity progression.
The study population consisted of older adults without clinically recognized cardiovascular disease drawn from the Multi-Ethnic Study of Atherosclerosis.
Vertebral BMD was quantified from noncontrast chest CT using a validated deep learning algorithm rather than dedicated bone densitometry.
This research suggests that lower bone density in the spine is linked to faster deterioration of brain white matter and more rapid cognitive decline in older adults. The study used a novel approach: instead of specialized bone density scans, researchers used an artificial intelligence algorithm to measure bone density from standard chest CT scans that participants had already undergone. They then tracked changes in brain health over several years using MRI and cognitive tests. Among 715 older adults (median age 69) who did not have known cardiovascular disease, those with lower bone density showed faster worsening in specific brain regions—particularly in the anterior limb of the internal capsule and the corpus callosum—as well as faster decline on two different cognitive assessments. The associations between bone density and brain health were modest but statistically meaningful, especially for cognitive outcomes. People with diabetes showed a particularly strong connection between lower bone density and worsening white matter lesions in the brain, suggesting that diabetes may amplify whatever shared biological pathways link bone and brain health. The brain regions affected—the internal capsule and corpus callosum—are important for connecting different parts of the brain and are known to be vulnerable during aging. This research suggests that routine chest CT scans, which millions of people receive each year for various medical reasons, could be repurposed to identify individuals at higher risk for accelerated brain aging—without any extra cost, radiation, or testing. If confirmed in future studies, this approach could help clinicians flag patients who might benefit from earlier monitoring or intervention for both bone and brain health. The finding also adds to growing evidence that skeletal health and brain health are intertwined, possibly through shared mechanisms involving inflammation, hormones, or vascular factors.
Momtazmanesh S, Hathaway Q, Bancks M, Bluemke D, Barr R, Post W, et al.. (2026). Deep Learning-derived Bone Mineral Density and Longitudinal White Matter Microstructure and Cognitive Decline: Multi-Ethnic Study of Atherosclerosis.. Radiology. https://doi.org/10.1148/radiol.260656