BACKGROUND: The epidemiology, treatment and prognosis of thoracolumbar vertebral fractures are fundamentally influenced by the bone quality of the patient. In individuals with healthy bone structure, a high-energy trauma is typically required to cause a fracture. In contrast, osteoporosis can cause fractures and also be present as a comorbid pathology in traumatic fractures. Comprehensive diagnostics and a precise classification are essential for appropriate treatment. MATERIAL AND METHOD: This narrative review outlines the diagnostic approach and classification of thoracolumbar vertebral fractures depending on the bone quality as the basis of treatment. RESULTS: In addition to a physical examination, conventional radiographs with the patient in a standing position and computed tomography (CT) scans of the affected region serve as the foundation for fracture classification. Supplementary magnetic resonance imaging (MRI) primarily assesses discoligamentous and neurological structures of the spine as well as the age of the fracture. In suspected cases of osteoporotic fractures, a short-tau inversion recovery (STIR) sequence of the entire thoracic and lumbar spine is recommended for reliable detection of bone marrow edema. For patients with healthy bone structure, the AO Spine classification is used, whereas the osteoporotic fracture (OF) classification and the OF score are applied in cases of osteoporosis.