As life expectancy rises the prevalence of osteoporosis also increases, which represents a growing burden for the populace and the healthcare system. Vertebral fractures are the most frequent type of all osteoporotic fractures. Since they can be diagnosed by radiology, these examinations are particularly important for devising suitable treatment strategies. The goal of activities undertaken by osteoporosis organizations is to put across to radiologists the importance of accurate evaluation of these fractures. Identification of osteoporotic vertebral fractures is however problematic since the transition from healthy vertebral bodies to those deformed by osteoporosis constitutes a continuum and it is often difficult in deformed vertebral bodies to distinguish between an osteoporotic fracture and a non-osteoporotic deformity. This overview attempts to heighten awareness of the significant role the radiologist plays in the diagnostic work-up of osteoporosis and to provide diagnostic aids for assessing osteoporotic vertebral fractures including differential diagnoses.