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STUDY DESIGN Retrospective cohort study of the Own the Bone database which is a fracture liaison service designed to improve recognition and treatment of osteoporosis. OBJECTIVE To use the Own the Bone (OTB) database to 1) examine the specific demographics of patients presenting with a low-energy clinical vertebral fracture (VFX) and, 2) compare demographic and fracture-specific risk factors between patients with clinical VFX versus patients with non-vertebral low-energy fracture (NVFX). SUMMARY OF BACKGROUND DATA Large database studies have described risk factors for developing VFX. It is well described that a history of previous VFX portends an increased risk of future VFX. Few studies have reported cohorts from a fracture liaison service such as the OTB initiative. METHODS 35,039 unique cases of fragility fracture occurred between 2009-2016 and were included in analysis. VFX accounted for 3,395 (9.9%) of the presenting fractures at OTB enrollment. The demographics, lifestyle factors, medication use and fracture-specific data for patients in the OTB registry with vertebral fractures were summarized and then statistically compared to those with non-vertebral fragility fractures. RESULTS The majority of VFX patients were Caucasian, post-menopausal women (74.4%). There was an increased likelihood of presenting with a vertebral fracture in patients who sustained a previous VFX after the age of 50, while patients who sustained a prior non-vertebral fracture (NVFX) were more likely to present with a subsequent NVFX. After controlling for patients with a history of fracture after the age of 50, VFX patients (vs. NVFX) were more likely to be age 70-79, class 1 obesity, with a history of taking anti-osteoporotic prescription medications. CONCLUSIONS Multiple factors were associated with a significantly increased risk of VFX compared with NVFX. Understanding the risk factors unique to fragility VFX is a critical component for targeting "at-risk" patients and preventing future osteoporosis-related fractures and their consequences. LEVEL OF EVIDENCE 4.