Objective:​ This multicenter study aimed to evaluate the association between volumetric bone mineral density (vBMD) and abdominal aortic calcification (AAC) in a Chinese population.

Methods:​ Quantitative computed tomography (QCT) and Agatston score (AS) were used to measure vBMD and AAC, respectively, in 3457 participants during 2013–2017. The association between vBMD and AAC was assessed using multivariate regression analysis, adjusted for age, residence, education, body mass index, and other cardiovascular risk factors.

Results:​ The mean age of women and men was 61.4 and 62.7 years, respectively. In total, 30.4% of women and 37.7% of men were found to have AAC. After full adjustment, higher vBMD was associated with lower AAC score (β, −0.095;​ 95% confidence interval [CI], −0.167 to −0.024;​ P = 0.0087) and lower AAC prevalence (odds ratio [OR], 0.873;​ 95% CI, 0.824 to 0.924;​ P < 0.0001) in men. Inverse trends were also observed in the association of vBMD quartile with AAC severity (lowest vs highest quartile;​ β = 0.235;​ 95% CI, 0.011 to 0.459;​ P_trend < 0.0001) and AAC prevalence (lowest vs highest quartile;​ OR = 1.329;​ 95% CI, 1.087 to 1.625;​ P_trend < 0.0001) in men. However, no significant result was obtained in women, except for the association between quartiles of vBMD and AAC score.

Conclusions:​ In our study, vBMD was inversely associated with AAC among men independent of age and shared risk factors. However, the association was not significant among women.