This retrospective study explored osteoporosis-bone metastasis association in newly diagnosed lung cancer. 400 subjects underwent LDCT+QCT for osteoporosis diagnosis; survival and Cox analyses were used. Precancer osteoporosis (HR=3.30, P<0.01) increased bone metastasis risk and shortened its onset time, while surgery (HR=0.31, P<0.01) was protective. Early osteoporosis screening in these patients is recommended. 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: Four hundred healthy individuals underwent LDCT screening, which was ultimately confirmed through histological and cytological diagnosis. QCT post-processing software was used to examine the trabecular bone volume density (vBMD), and osteoporosis was diagnosed according to the diagnostic criteria for osteoporosis by the American Society of Radiology using QCT imaging. 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: COX univariate 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.