Osteoporotic vertebral fractures suspected at clinical evaluation require radiological confirmation. Most radiologists make the diagnosis of vertebral fracture on the basis of a qualitative impression. However, unlike other fractures, vertebral fractures are commonly found on radiographs obtained for other reasons in patients who do not show signs or symptoms suggestive of fractures. Radiologists qualitatively analyze radiographs of the thoracolumbar spine to identify vertebral fractures in patients whose clinical indications suggest trauma, osteoporosis, malignancy, or acute back pain. The accuracy of decision-making process can be enhanced by additional radiographic projections or by complementary examinations including DXA (Dual Energy X-ray Absorptiometry) morphometry, bone scan, CT, or MRI. The importance of imaging is highlighted by the fact that only about one in four vertebral fractures is recognized on the basis of clinical evaluations without radiographs. Radiographs may include lateral and AP (anterior/posterior) X-rays of the affected spinal segments. The physician may request bone scan and/or CT to help identify the location of the fracture, its status (stable versus unstable). Furthermore, an MRI scan may be performed if neurologic deficit, soft tissue trauma or hematoma are suspected.