Fragility fractures, particularly in the hip and spine, are the most common complication of osteoporosis. In the US, approximately 1-1.5 million vertebral compression fractures (VCFs) occur annually. While patients may present with sudden onset of low back pain and limited mobility, more than two-thirds of VCFs are asymptomatic and are detected incidentally. X-rays are the standard imaging modality for diagnosis, with CT and MRI indicated if neurological deficits are present or a malignant cause is considered. Initial management is often non-surgical, with medications, physical therapy, and bracing. Surgical management in the form of cement augmentation (kyphoplasty or vertebroplasty) or instrumented fusion can be considered after failure of non-operative treatment, cases of deformity, or neurologic deficits. Subsequent VCFs occur frequently, and risk factors for refracture include advanced age, low bone mineral density, and low BMI. Treatment of primary VCFs with anti-resorptive medication is essential to reduce the risk of subsequent fractures.