The majority of vertebral deformities are asymptomatic and thus definition is normally based on radiographic appearance. There are no internationally agreed criteria for vertebral fracture based on radiographic appearance. A variety of morphometric methods have been developed to ascertain changes in vertebral shape based on a reduction in vertebral height. Criteria have to be established to determine what cutoff constitutes abnormality. An alternative is to adopt a semiquantitative grading using clinical observations of a experienced radiologist. This approach enhances specificity by excluding nonosteoporotic causes of changing vertebral shape. Such methods, however, may be subject to difficulties in standardization.