BACKGROUND: Some studies have shown that the hounsfield units (HU) value based on lumbar CT can be used to screen osteoporosis. At present, the number of patients with pulmonary infection has increased; the number of patients with pulmonary infection and type 2 diabetes is also increasing, which increases the utilization rate of chest CT. OBJECTIVE: To investigate the role of lumbar 1 vertebral body HU value based on chest CT in the screening of type 2 diabetes mellitus osteoporosis. METHODS: The clinical data of 244 patients with type 2 diabetes mellitus treated in the First Affiliated Hospital of Chengdu Medical College from June 2020 to June 2022 were analyzed retrospectively. The bone mineral density was obtained by dual-energy X-ray absorptiometry. According to WHO’s diagnostic criteria for osteoporosis, the subjects were divided into the non-osteoporosis group (n=120) and the osteoporosis group (n=124). The general condition, T value and HU value of lumbar 1 vertebra in chest CT were compared, and the relationship between the HU value and T value of each position was analyzed and the accuracy of type 2 diabetes mellitus osteoporosis was evaluated. RESULTS AND CONCLUSION: (1) There was no significant difference in sex, age, body mass index, glycosylated hemoglobin, mean blood glucose, calcium (Ca), phosphorus (P), time of type 2 diabetes mellitus, history of hypertension and history of hyperlipidemia between the two groups (P > 0.05). (2) The HU value was positively correlated with the lowest T value of the hip (r=0.619, P < 0.01); the HU value was positively correlated with the hip T value (r=0.584, P < 0.01), and the HU value was positively correlated with the femoral neck T value (r=0.641, P < 0.01). When the HU value was 98, the prediction of type 2 diabetes mellitus osteoporosis had good accuracy, and the sensitivity was 70.8%. (3) It is concluded that the HU value of the lumbar 1 vertebra based on chest CT examination is of good value for osteoporosis screening in patients with type 2 diabetes mellitus, and may be an opportunistic and cost-free supplementary screening method for type 2 diabetes mellitus osteoporosis. [ABSTRACT FROM AUTHOR]