In a series of 70 men with vertebral crush fractures, 38 (54%) were found to have an underlying secondary cause of osteoporosis such as hypogonadism (16%), oral steroid therapy (13%), neoplastic disease (9%), excess alcohol consumption (6%), gastric surgery (1%) or a combination of these factors (10%). The diagnosis of secondary osteoporosis was not always apparent from the clinical history and physical examination, suggesting that appropriate investigations should be performed in all men with vertebral crush fractures.