Aim: Opportunistic osteoporosis screening in China is more cost-effective when using low-dose chest CT (LDCT) combined with quantitative computed tomography technology (QCT). We retrospectively investigated the association between osteoporosis and bone metastasis in patients with newly diagnosed lung cancer. Materials: Trabecular volumetric bone mineral density (vBMD) of any two ver-tebral bodies spanning T12 to L2 within the lung CT scan field was quantified using QCT-Pro software. Osteoporosis was diagnosed in compliance with the Chinese Guide-lines for the Diagnosis of Osteoporosis by Quantitative Computed Tomography (QCT) (2018) and the QCT-based osteoporosis imaging criteria established by the American College of Radiology (ACR). Kaplan-Meier survival analysis was used to assess survival time, and Cox proportional hazards regression analysis was employed to ascertain the factors linked with bone metastases. Results: Four hundred healthy individuals underwent LDCT screening, which was ultimately confirmed through histological and cytological diagnosis. COX univari-ate and multivariate regression analyses revealed that newly diagnosed lung cancer patients with osteoporosis (HR, 3.30; 95% CI, 1.90- 5.73; P <0.01) and surgery (HR, 0.31; 95% CI, 0.17- 0.57; P <0.01) were associated with a difference in the risk of bone metastasis. Compared to individuals without precancerous osteoporosis and surgery, the median time for the development of bone metastasis was shorter for those with precancer osteoporosis and those without surgery (median time to bone metastasis development, 35 months; 95% CI, 26-NA months; 44 months; 95% CI, 31-NA months; P <0.01). Conclusions: Newly diagnosed lung cancer with osteoporosis is associated with a risk of bone metastasis and accelerated progression of bone metastasis. Our findings highlight the need for early identification of osteoporosis among newly diagnosed lung cancer patients.