This article highlights the expanding burden of osteoporosis in West Virginia. WV ranks second nationally in the percentage of its population that is > or = 65 years of age. Our older population increases the risk of osteoporosis and fracture; the most recent data indicates that 77% of our women age 50 and older have osteoporosis or low bone mass. The lifetime risk of osteoporotic related fracture is alarming and occurs in 50% of females and 25% of males age 50 and older. The risk of osteoporosis related hip fracture in women is equal to the combined risk of breast, uterine or ovarian cancer with the annual risk of osteoporotic fracture greater than the combined risk of breast cancer, stroke and heart attack. Detecting individuals at risk for fracture has been aided by an internationally validated fracture prediction tool from the World Health Organization -- FRAX. The FRAX tool can be incorporated into protocols to help minimize barriers to effective osteoporosis screening and treatment in WV.