Osteoporotic vertebral fracture often results in asymptomatic and atraumatic deformity of vertebral body, therefore the qualitative radiological evaluation alone may lead to disagreement about whether a vertebra is fractured. Morphometry based on measurements of vertebral body heights is a reliable and reproducible technique for vertebral fracture assessment. Quantitative morphometry may be performed on lateral thoracolumbar digitized radiographs (Morphometric X-rays) or on images provided from densitometers (Morphometric X-rays-absorptiometry). Accurate identification of vertebral fractures depends on comparisons to dimensions among normal vertebrae. It has not yet been established which population, if pre- or post-menopausal women, should be considered as a normal reference. Because there is no gold standard for defining a vertebral fracture, have been developed various morphometric criteria to establish a threshold of vertebral height reduction diagnostic for fracture. The more accurate detection of vertebral fractures requires a combination of vertebral height measurements and relating the measurements to the normal values. Several authors have demonstrated that the morphometric methods have high sensitivity, but poor specificity for diagnosis of vertebral fractures. In fact the morphometry identifies as fractures some vertebral deformities that may represent developmental abnormalities. Instead an expert eye can distinguish between true fractures and vertebral anomalies. Therefore, the computerized morphometry, to assess both prevalent and incident vertebral fractures, should be performed in conjunction with the semiquantitative visual method by the trained radiologists.