The study aimed to determine hospital-based prevalence of vertebral fractures in postmenopausal Saudi Arabian women. Chest radiographs from consecutive Saudi women over the age of 50 years visiting the emergency room at King Fahd Hospital of the University were evaluated. Of 785 radiographs analysed 159 (20.3%) patients had 198 vertebral fractures. The mean age of the women was 65.7 (SD 8.5) years. In only 37.8% of the radiographs with fractures was a vertebral fracture highlighted in the radiologist's report, and only 13.2% of the women with vertebral fractures were on antiresorptive therapy for osteoporosis.