Osteoporosis is a common cause of vertebral compression fractures. Although vertebroplasty is used to treat the pain, the risk of additional compression fractures is very high in these patients. Adequate evaluation and management of the underlying osteoporosis is critical to reducing the risk of subsequent fractures. Such an evaluation involves understanding the underlying physiology of osteoporosis and the role of calcium, vitamin D, prescription medication, and lifestyle changes. This brief review is intended to familiarize neuroradiologists with these aspects so they can advise patients about optimizing fracture risk reduction.