SummaryBackground and objectives Low bone mineral density and coronary artery calcification (CAC) are highly prevalent among chronic kidney disease (CKD) patients, and both conditions are strongly associated with higher mortality. The study presented here aimed to investigate whether reduced vertebral bone density (VBD) was associated with the presence of CAC in the earlier stages of CKD.Design, setting, participants, & measurements Seventy-two nondialyzed CKD patients (age 52 Ϯ 11.7 years, 70% male, 42% diabetics, creatinine clearance 40.4 Ϯ 18.2 ml/min per 1.73 m 2 ) were studied. VBD and CAC were quantified by computed tomography.Results CAC Ͼ 10 Agatston units (AU) was observed in 50% of the patients (median 120 AU [interquartile range 32 to 584 AU]), and a calcification score Ն 400 AU was found in 19% (736 [527 to 1012] AU). VBD (190 Ϯ 52 Hounsfield units) correlated inversely with age (r ϭ Ϫ0.41, P Ͻ 0.001) and calcium score (r ϭ Ϫ0.31, P ϭ 0.01), and no correlation was found with gender, creatinine clearance, proteinuria, lipid profile, mineral parameters, body mass index, and diabetes. Patients in the lowest tertile of VBD had expressively increased calcium score in comparison to the middle and highest tertile groups. In the multiple logistic regression analysis adjusting for confounding variables, low VBD was independently associated with the presence of CAC.Conclusions Low VBD was associated with CAC in nondialyzed CKD patients. The authors suggest that low VBD might constitute another nontraditional risk factor for cardiovascular disease in CKD.