Researchers at Johns Hopkins University have discovered that lower spinal bone density is linked to faster cognitive decline and accelerated age-related brain white matter damage.
The study, led by Dr. Sara Momtazmanesh, was published on Tuesday, September 22, 2026, in Radiology, a journal of the Radiological Society of North America. The research shows that low volumetric bone mineral density in the thoracic vertebrae correlates with damaging microstructural changes in the brain.
Bone mineral density measures the amount of essential minerals, including calcium, present within a specific volume of bone tissue. When bone mineral density drops, bones become weak, brittle, and significantly more susceptible to fractures. While bone density loss is widely recognized in skeletal conditions such as osteoporosis, relatively little prior research has examined the relationship between low bone density and deteriorating brain function.
Brain Imaging and MESA Study Data
To investigate the connection between bone loss and cognitive health, the Johns Hopkins team performed a secondary analysis of data gathered through the Multi-Ethnic Study of Atherosclerosis, widely known as MESA. Participants in the MESA cohort had previously undergone unenhanced chest computed tomography scans, multimodal brain magnetic resonance imaging, and standard clinical cognitive testing.
The research team utilized an advanced deep learning algorithm developed in the laboratory of Dr. Shadpour Demehri. The artificial intelligence tool analyzed unenhanced chest CT scans from 2,086 MESA participants to calculate their baseline volumetric bone mineral density across the thoracic vertebrae.
From that initial group, the final study cohort comprised 715 participants who possessed an established baseline volumetric bone density measurement alongside complete brain MRI scans and cognitive test scores.
Radiologists analyzed the brain MRI scans for two key indicators of brain degeneration: white matter hyperintensities and reduced fractional anisotropy. Both metrics represent microstructural changes in brain tissue that are closely linked to cognitive impairment and an elevated risk of developing dementia.
Longitudinal tracking data were available for specific subsets of the study group. The researchers analyzed longitudinal changes in white matter hyperintensities across 408 participants and longitudinal fractional anisotropy measurements across 405 participants.
Specific Regions of Cognitive Impact
The statistical analysis revealed that lower baseline volumetric bone mineral density was consistently associated with a faster rate of global cognitive decline over time.
The researchers also identified strong associations within specific anatomical regions of the brain. Lower volumetric bone density was associated with a greater accumulation of white matter hyperintensities in the corpus callosum, the central nerve bundle that supports executive functions, working memory, and attention.
Furthermore, lower bone density was associated with a steeper decline in total fractional anisotropy across white matter in the anterior limb of the internal capsule. This neural pathway is also intimately involved in executive function and cognitive control.
Underlying Metabolic Mechanisms
Dr. Demehri stated in a journal press release that the study represents the first longitudinal secondary analysis to directly link baseline vertebral bone mineral density with structural changes in white matter, the progression of white matter hyperintensities, and cognitive decline.
He added that the comprehensive evaluation, which combined diagnostic imaging with clinical assessments, clearly demonstrates that baseline bone density correlates with both functional and structural markers of age-related brain degeneration.
However, the research team emphasized that these findings do not indicate that osteoporosis directly causes dementia.
Dr. Demehri clarified that the investigation does not establish a direct cause-and-effect relationship, but rather points to an underlying metabolic syndrome that can simultaneously cause degeneration in both bone and brain tissues.
He noted that the co-occurrence of bone loss and brain degeneration likely reflects common metabolic factors associated with aging. These shared drivers include insulin resistance, dyslipidemia, and hormonal changes during menopause, rather than a direct mechanism where bone tissue directly impacts the brain.
Clinical Applications and Artificial Intelligence
The researchers highlighted that identifying individuals with low volumetric bone mineral density could help clinicians spot patients who are at risk of suffering parallel skeletal and neurological decline. Early identification could enable earlier diagnostic screening and shared management of common risk factors.
Dr. Momtazmanesh explained that chest CT scans are already routinely ordered for a wide variety of medical reasons, including lung cancer screening, coronary calcium scoring, and the monitoring of pulmonary nodules.
She noted that these existing diagnostic scans could provide a timely, opportunistic measurement of thoracic spine bone density, yielding crucial early clues regarding a patient's risk of cognitive loss without requiring additional imaging procedures.
Dr. Demehri agreed, observing that routine diagnostic images contain an immense amount of uncaptured data that artificial intelligence can now synthesize at scale across multiple organ systems.
He added that AI analysis creates a powerful opportunity to connect coexisting age-related pathologies that have traditionally been studied in isolation, opening new avenues to identify shared biological pathways and potential common causal mechanisms.
