Aortic calcification is a major risk factor for cardiovascular disease (CVD) related deaths. We investigated the relation between mortality and aspects of number, size, morphology and distribution of calcified plaques in the lumbar aorta and BMD of postmenopausal women. 308 women aged 48 to 76 were followed for 8.3±0.3 years and CVD deaths were recorded. BMD and several aortic calcification markers were computed: number, morphology, distribution, from outlines of the calcified plaques in lumbar X-rays. These markers were compared to BMD, SCORE card, Framingham score, and the Aortic Calcification Severity score - AC24. AC24 adjusted by age, waist circumference, and triglyceride levels (ATW) predicted mortality in postmenopausal women (CVD p=0.03, All-cause p=0.006). The SCORE card and the Framingham score resulted in mortality odds ratios (MOR) of 5.0 and 5.2 - defining high risk as =6 and =18, respectively. BMD and BMD adjusted for ATW was lower in the group of deceased than in survivors (p<0.001) and negatively correlated to calcification markers in survivors (R2= 0.27, p<0.001). All scores based on the calcification geometry provided highly significant predictions. The number of calcified deposits (NCD) was a significant predictor even after adjustment by the AC24 score (p=0.002). The AC24 score adjusted by NCD had no predictive value (p=0.53). The high risk patients (NCD = 13) had MOR 12. The morphological atherosclerosis calcification distribution(MACD) index provided MOR 20 which was significantly higher than AC24 and any single or multivariate metabolic/physical marker. BMD correlates with AC24 among CVD dead patients (p=0.03) unlike MACD (p=0.43). The recent MACD-index provides a unique combination of morphology and distribution of aortic calcifications, factors that in a combination increase the biological relevance of the index by emphasizing that smaller plaques with a spread elongated morphology have a larger growth potential and thereby subsequent rupture potential. It includes the predictive power of BMD unlike the AC24 index. Thereby, in the current cohort with a long term follow-up the MACD-index is a convincingly strong predictor of CVD mortality, with an odds ratio of 20, of postmenopausal death related to CVD events.