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Objectives: To describe the development, implementation, and financial aspects of a sustainable osteoporosis screening service in a community pharmacy and report osteoporosis risk factors for women screened during the 48 months in which the screening service was in operation. Setting: An independent community pharmacy (Main at Locust Pharmacy Clinic) in Davenport, Iowa, beginning in 1999. Practice description: The osteoporosis screening service was provided by a staff pharmacist, a pharmacy resident, or a combination of a pharmacist and a resident. The service included use of the Hologic Sahara Bone Sonometer at the heel and education of the patient. Patient education consisted of a discussion of screening results, an overview of osteoporosis, and recommendations to address risk factors. Practice innovation: For patients who received osteoporosis screening, an overall cumulative risk score and a cumulative modifiable risk score were calculated. Patients were identified as having high (T-score ≤-1), moderate (-1 < T-score <0), or low (T-score ≥0) risk. An analysis was performed to determine the net financial gain or loss of osteoporosis screening. Intervention: Osteoporosis screening service. Main outcome measures: T-score, overall cumulative risk score, cumulative modifiable risk score, and net financial gain of service. Results: A total of 444 women received the osteoporosis screening service during 48 months. More than 90% of the women had an overall cumulative risk score of at least 3, and 83.3% had at least one modifiable risk factor. According to the bone density tests, about 58% of the women were at high risk for osteoporosis and 25.7% were at moderate risk. The service had a net gain if provided by a pharmacist ($4,823.72), a resident ($8,153.72), or a combination of a pharmacist and a resident ($6,488.72). Conclusion: This pharmacy-based osteoporosis screening service effectively identified patients at risk for osteoporosis and was sustainable for 48 months. Other community pharmacies are encouraged to offer similar services. [ABSTRACT FROM AUTHOR]