Osteoporosis of the hip is associated with hip fracture, a devastating outcome on both an individual and aggregate basis. Height loss is a frequent manifestation of vertebral osteoporosis and is simple to evaluate in the clinical setting. The goal of this study was to determine whether height loss is significantly associated with low bone mineral density at the femur, using a retrospective review of cross-sectional data from 2108 women referred for a bone density scan. Collected data included self-reported maximum adult height, current height, and total hip bone mineral density, along with other demographic and risk factor information. We then investigated the relationship between height loss and osteoporosis using multinomial logistic regression modeling. We found that height loss of 2 in. or more is a highly significant predictor of osteoporosis at the hip. In particular, the odds women had osteoporosis at the hip, as determined by total hip bone mineral density, increased 4.4 times (95% confidence interval, 2.6-7.4) if the women had lost > or = 2 but < 3 in. of height. In addition, women with at least 3 in. of height loss had odds of osteoporosis of the hip that were 9.6 times greater (95% confidence interval, 4.8-19.2) than women with less than an inch of height loss. These odds ratios were adjusted for the confounding variables of age, weight, and maximum adult height. Our findings suggest loss of height may be an important clue in detecting osteoporosis of the hip, implying that evaluation of height loss should be routine in the outpatient setting.