Osteoporosis currently affects 1.2 million Australians, most of whom do not know they have the disease. Without intervention, this is expected to increase to 3 million by 2021 as a result of population ageing. There are also now 6.3 million Australians with osteopenia. General practitioners and their patients often overlook bone health and, as a result, osteoporosis is often not diagnosed until fragility fractures occur. There is also a lack of an accepted strategy for osteoporosis prevention in Australia. Currently, treatment is based on bone mineral density (BMD) measurement and/or a prior fracture. However, more than 50% of women and 70% of men who sustain fragility fractures do not have BMD in the osteoporosis range (T score < − 2.5). This represents a “prevention paradox”, which is the basis for developing the population-based prevention strategy outlined here.