Osteoporosis is an increasingly prevalent chronic metabolic bone disease, characterized by low bone mass that subsequently leads to bone fractures. Vertebral fractures are the most common and the most debilitating of osteoporotic fractures. People with osteoporotic vertebral fractures present a unique challenge to rehabilitation nurses. A better understanding of the complex pathophysiological processes that contribute to this disability will help nurses provide more comprehensive care and education to this growing segment of the population. This article presents an overview of normal physiology and a discussion of the pathophysiological changes that occur in the skeletal, endocrine, and neurological systems throughout the development of osteoporotic vertebral fractures.