This study investigated the pain and disability experienced by 85 consecutive postmenopausal Caucasian women, average age 64 years (range 50-82), with spinal osteoporosis, referred to a specialist bone clinic. Symptoms were related to the numbers and severity of vertebral deformities, and degree of kyphosis. Persistent back pain was experienced by 54 (63%) in the lumbar spine and 53 (62%) in the thoracic spine. The severity of thoracic but not lumbar back pain was significantly related by Kendall rank correlation to degree of kyphosis (R = 0.255, p < 0.01), numbers of collapsed vertebrae (R = 0.279, p < 0.01) and a summed score of the severity of collapse for all vertebrae (R = 0.253, p < 0.01). The severity and duration of thoracic back pain was also significantly related to numbers of collapsed vertebrae from T4-T8 alone. Sleep was disturbed in 60%, difficulty obtaining suitable clothes was found in 42% and difficulties with functional activities in 47%, although these were severe in only 10%. Significant associations were also found between scores of osteoporosis severity and sleep disturbance, difficulties with clothes and many functional activities. We conclude that in patients with spinal osteoporosis coming to medical attention, assessment and management of pain, disability, sleep pattern and difficulties with obtaining clothes are required for optimal care.