Vertebral fractures are the most common clinical manifestation of osteoporosis. In the United States alone, approximately 550 000 individual experience a vertebral fracture each year, resulting in significant pain and short-term disability.1 The morbidity caused by symptomatic vertebral fractures is reflected by the more 150 000 hospitalizations per year. Established risk factors for vertebral fractures mirror those for factures at other sites and include advanced age, lower bone mineral density, falling, smoking, and inadequate calcium intake. An extremely important point for patients and clinicians is that a vertebral fracture is a very strong predictor of subsequent fractures, both vertebral and nonvertebral. Most clinical guidelines recommend pharmacologic therapy, regardless of bone mineral density, in an older individual with a new vertebral facture.