Background/Aims: Abdominal aortic calcification (AAC) is associated with incident clinical cardiovascular disease independent of other clinical risk factors. The aorta lies immediately anterior to the lumbar spine, and AAC can be accurately scored on bone density lateral spine images. Our objective was to estimate the proportion of individuals 65.80 years old undergoing bone densitometry who are not known a priori to be at high risk of cardiovascular disease (based on prior diagnoses and Framingham hard coronary heart disease [CHD] 10-year risk score), but who have a high level of AAC (AAC-24 Framingham score > 5). Methods: AAC was scored on lateral spine bone density images for 1,499 randomly selected patients age 65.80 at a large urban community health care delivery organization, blinded to patient characteristics. Established diagnoses of cardiovascular disease or diabetes mellitus were determined by identification of appropriate ICD-9 diagnosis codes at provider visits. Framingham 10-year hard CHD risk scores were calculated from clinical data (systolic blood pressure, total and high-density-lipoprotein cholesterol, smoking status, use of antihypertensive medication) extracted from the electronic health record. Results: Mean age of the study cohort was 71 years; 92.9% were female, 94.1% were Caucasian, 14.0% had preexisting cardiovascular disease, 10.7% had preexisting diabetes mellitus, and 24.7% had a Framingham hard CHD risk score > 7.5%. A total of 490 patients (32.7%) had no AAC, 603 (40.2%) had mild to moderate AAC (AAC-24 score of 1 to 4), and 406 (27.1%) had a high level of AAC; 184 patients (12.3%) had both a high level of AAC and were not previously known to be at high risk based on preexisting clinical cardiovascular disease, diabetes mellitus or a Framingham hard CHD risk score > 7.5%. Conclusion: The proportion of those age 65 to 80 undergoing bone densitometry who are not known to be at high risk of incident cardiovascular disease but who have high AAC is sufficient that densitometric lateral spine imaging at the time of bone densitometry may have a role in cardiovascular disease risk screening, considering bone densitometry is recommended at least once for all women > 65 years old and men > 70 years.