OBJECTIVES: Osteoporotic vertebral fractures (OVF) are an important health concern which remain underdiagnosed in 70% cases. According to recent data, approximately 450,000 and 700,000 symptomatic vertebral fractures are diagnosed each year in the EU and in the US, respectively. The aim of this study is to understand the perceptions of primary care physicians (PCP)  with regards to diagnosis and management of OVF in their consultations. METHODS: Exploratory design using qualitative methodology. 15 semi-structured interviews, recorded and later transcribed, with PCP between 2006-2007. Subsequently two investigators from the research team carried out the analysis and crosschecked results by identifying categories. RESULTS: Suspected diagnosis of OFV is based on anamnesis, physical examination and a simple X-ray. Physicians inform that this work is not executed systematically in daily consultations and sometimes chronic back pain is not studied in depth. The differential diagnosis is perceived as a complex process, leading to confusion (back pain, osteoarthritis, rheumatoid arthritis and osteoporosis). PCP agree radiology is useful in detecting a vertebral fracture. PCP refer patients to other specialists when they find difficulties reaching a diagnosis (history of fractures, repeated fractures, persistent pain, suspicion of secondary osteoporosis,etc) and also when they are not allowed to carry out a densitometry in their primary care health centre. Regarding this test, participants described a lack of both consensus and shared guidelines in its use. Minimally invasive surgical techniques are not widely known about and their access is irregular even when medical treatments are ineffective. CONCLUSIONS: Some recommendations have recently been proposed for OVF management.  This study has identified a mismatch between the proposed recommendations and the ordinary clinical practice. PCP´s diagnosis is influenced by their personal interest in the osteoporosis field, the degree to which they rely on published evidence and the proximity of surgical teams involved in this area.