Osteoporosis is a systemic skeletal disease characterized by reduced bone mass and microarchitectural deterioration. These lead to subsequent increase in bone fragility and susceptibility to low-trauma or atraumatic fractures, most commonly vertebral fractures but also fractures of hip and wrist. These have a significant impact on morbidity, mortality, and health care cost. Studies have demonstrated that the presence of vertebral fractures is an independent and significant predictor of the increased risk for further fractures. The occurrence of a vertebral fracture is often clinically asymptomatic, and many of these fractures, therefore, remain undiagnosed. Recently, a number of techniques have been developed that allow for reliable identification of vertebral fractures on radiographs. The two most widely used methods in clinical research are the semiquantitative assessment of vertebral deformities, which is based on visual evaluation, and the quantitative approach, which is based on different morphometric criteria. In our practice for osteoporosis evaluation we use the Genant semiquantitative approach-an accurate and reproducible method, tested and applied in many clinical studies. The newest generation of fan-beam dual energy X-ray absorptiometry (DXA) systems delivering "high-resolution" lateral spine images offer a potential practical alternative to radiographs for clinical vertebral fracture analysis. The advantages of using DXA over conventional X-ray devices are its minimal radiation exposure and high-speed image acquisition. It also allows combined evaluation of vertebral fracture status and bone mineral density, which could become a standard for patient assessment in osteoporosis.