Abstract Introduction: Patients with pulmonary diseases face an elevated risk of osteoporosis. Conventional diagnosis relies on quantitative computed tomography (QCT), which delivers a high radiation dose and requires a dedicated scan. Whether conventional chest CT can be used for osteoporosis screening remains uncertain. Methods: A deep learning system was used to measure bone mineral density (BMD) in routine chest CT scans for osteoporosis screening, with QCT as the reference standard.