Vertebral Fracture Assessment (VFA) is a new method, based on fan-beam DXA and used for diagnostic imaging of vertebral bodies. Vertebral fractures are among the most frequent osteoporotic bone injuries; however, their identification is rather difficult. Their clinical significance is very high, as they are a risk factor for subsequent fractures, both vertebral and non-vertebral, causing back pain and kyphosis, increasing respiratory and gastric discomfort and, eventually, leading to disability and death. The most important advantages of the VFA method include: safety (low radiation dose), the possibility to be combined with densitometry (convenience for patient and staff) and higher cost-effectiveness vs. classic X-ray examination. VFA sensitivity and specificity are similar to those of classic X-ray, regarding the diagnostics of grade 2 and 3 vertebral fractures. The main disadvantage of VFA is its lower resolution vs. that of X-ray. Patients with densitometric features of osteopenia, in whom the diagnosis of vertebral fractures may bias their therapeutic qualification, are the primary candidates for VFA examination.