Many osteoporosis-related vertebral fractures are unappreciated but their detection is important as their presence increases future fracture risk. We found height loss is a useful tool in detecting patients with vertebral fractures, low bone mineral density, and vitamin D deficiency which may lead to improvements in patient care. This study aimed to determine if/how height loss can be used to identify patients with vertebral fractures, low bone mineral density, and vitamin D deficiency. A hospital database search in which four patient groups including those with a diagnosis of osteoporosis-related vertebral fracture, osteoporosis, osteopenia, or vitamin D deficiency and a control group were evaluated for chart-documented height loss over an average 3 1/2 to 4-year time period. Data was retrieved from 66,021 patients (25,792 men and 40,229 women). A height loss of 1, 2, 3, and 4 cm had a sensitivity of 42, 32, 19, and 14% in detecting vertebral fractures, respectively. Positive likelihood ratios for detecting vertebral fractures were 1.73, 2.35, and 2.89 at 2, 3, and 4 cm of height loss, respectively. Height loss had lower sensitivities and positive likelihood ratios for detecting low bone mineral density and vitamin D deficiency compared to vertebral fractures. Specificity of 1, 2, 3, and 4 cm of height loss was 70, 82, 92, and 95%, respectively. The odds ratios for a patient who loses 1 cm of height being in one of the four diagnostic groups compared to a patient who loses no height was higher for younger and male patients. This study demonstrated that prospective height loss is an effective tool to identify patients with vertebral fractures, low bone mineral density, and vitamin D deficiency although a lack of height loss does not rule out these diagnoses. If significant height loss is present, the high positive likelihood ratios support a further workup.