Osteoporotic vertebral fractures are associated with increased morbidity and mortality. Morbidity associated with these fractures includes pain and decreased physical function, which have a significant impact on the quality of life. The detection of osteoporotic vertebral fracture is based mainly on the identification of vertebral collapse, but this can be misleading in the presence of a fracture without radiologic collapse. And the diagnosis of vertebral fractures in simple radiographs is difficult because of normal variants and degenerative change of vertebrae. We review the various methods for evaluating osteoporotic vertebral fractures based on simple radiography or dual-energy X-ray absorptiometry (DXA). The preferred method may be Genant's semiquantitative method which was developed in an attempt to reduce subjectivity associated with visual diagnosis of osteoporotic vertebral fracture. Recently, vertebral fracture assessment (VFA) by DXA can be used to detect vertebral fractures in asymptomatic patients undergoing routine BMD measurements. Yoshida's classification is useful alternative method in the incidental vertebral fracture diagnosis with a morphological change in the anterior bone cortex.