Osteoporosis is a worldwide disease with an increasing incidence that affects a large number of older adults. Vertebral compression fractures are the most common type of osteoporotic fracture and can serve as a strong indicator of future fracture risk, but such vertebral compression fractures frequently remain clinically silent. Recognizing prevalent osteoporosis through identification of asymptomatic vertebral fractures found incidentally on imaging studies represents one avenue for improving bone health among populations. In this lecture we will review diagnosis and management of osteoporosis, with an emphasis on improving rates of diagnosis and treatment using health systems approaches.