We, and others, have reported that osteoporosis in men is more prevalent than previously believed. However, despite growing attention to the condition, screening strategies driven by unreliable historical data such as height loss, are relatively insensitive and non-specific. Because of our concern that many men with osteoporosis may not be identified as at-risk, we performed a computer-based review of chest x-ray (CXR) reports in the VA VISTA clinical database, looking for unrecognized vertebral fractures. We examined all CXR reports between July 1, 2001 and June 30, 2003, scanning for the terms “compression” or “wedg- (to encompass “wedge” or “wedging”)” but without the negative modifiers “no compression” or “no acute compression” or “no fracture.” During the specified time period, 26,994 CXR were performed on 18,069 patients. 22,494 (83.3% of the total) CXR were done in men $ 50 yrs of age. Of these, 908 (4.0%) reports contained at least one of the key phrases suggesting osteoporosis, and no negative modifiers. Thus, a significant fraction of middle-aged and older men may have unrecognized osteoporosis severe enough to result in vertebral fracture. We conclude that computerized screening of CXR reports may potentially represent an effective strategy to aid clinicians in identifying more men with osteoporosis at risk for further fractures.