Summary <p>A community-based prescreening approach using the Austrian FRAX® model and portable pulse-echo ultrasound identified a substantial proportion of adults with findings that may warrant further osteoporosis evaluation. Our results suggest that local prescreening pathways could support earlier identification and referral, particularly in women.</p> Purpose <p>Early identification of adults at increased osteoporosis risk remains challenging. We evaluated a community-based prescreening approach using Austrian FRAX® and portable pulse-echo ultrasound in adults from Tyrol, Western Austria.</p> Methods <p>Adults aged 50–90 years voluntarily attended free community screening events. Participants completed the Austrian FRAX questionnaire and underwent tibial pulse-echo ultrasound (Bindex®), from which the density index (DI) was derived. FRAX probabilities were categorized using updated Austrian thresholds, and DI was classified as green (&gt; 0.844), yellow (0.779–0.844), or red (&lt; 0.779). Combined FRAX and DI classifications were used to describe the burden and distribution of findings relevant to further osteoporosis assessment.</p> Results <p>A total of 664 adults participated. Women had higher FRAX-estimated fracture probabilities and lower DI values than men. Median 10-year major osteoporotic fracture probability was 6.6% in women and 4.6% in men, and median hip fracture probability was 1.2% and 0.8%, respectively. DI was in the green range in 54.4% of women and 92.9% of men. When FRAX and DI were combined, 30.2% of women had abnormal DI despite FRAX probabilities below Austrian intervention thresholds, whereas discordance was uncommon in men.</p> Conclusion <p>Community-based prescreening identified a substantial number of adults who may benefit from formal osteoporosis assessment. In a region with high fracture burden and persistent care gaps, such local pathways could support earlier identification of osteoporosis risk.</p>