Objective <p>This study aimed to develop and validate a predictive model to detect osteoporosis using radiomic features and machine learning (ML) approaches from lumbar spine computed tomography (CT) images during an abdominal CT examination.</p> Methods <p>A total of 509 patients who underwent both quantitative CT (QCT) and abdominal CT examinations (training group, n = 279; internal validation group, n = 120; external validation group, n = 110) were analyzed in this retrospective study from two centers. Radiomic features were extracted from the lumbar spine CT images. Seven radiomic-based ML models, including logistic regression (LR), Bernoulli, Gaussian NB, SGD, decision tree, support vector machine (SVM), and K-nearest neighbor (KNN) models, were constructed. The performance of the models was assessed using the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).</p> Results <p>The radiomic model based on LR in the internal validation group and external validation group had excellent performance, with an AUC of 0.960 and 0.786 for differentiating osteoporosis from normal BMD and osteopenia, respectively. The radiomic model based on LR in the internal validation group and Gaussian NB model in the external validation group yielded the highest performance, with an AUC of 0.905 and 0.839 for discriminating normal BMD from osteopenia and osteoporosis, respectively. DCA in the internal validation group revealed that the LR model had greater net benefit than the other models in differentiating osteoporosis from normal BMD and osteopenia.</p> Conclusion <p>Radiomic-based ML approaches may be used to predict osteoporosis from abdominal CT images and as a tool for opportunistic osteoporosis screening.</p>