Diffusion-weighted imaging of the musculoskeletal system including the spine is a new MR imaging method. Several studies have shown significantly different diffusivities for various pathologic conditions such as edema and tumor. The specificity of diagnosis may be increased and therapeutic effects may be monitored. Diffusion-weighted sequences especially have been shown to be an additional tool for differentiating vertebral fractures caused by osteoporotic collapse with bone marrow edema and metastatic collapse. Inclusion criteria should include: (1) unknown reason for the vertebral collapse, (2) lack of sclerosis, and (3) no prior therapy. Patients with trauma or treated metastases may exhibit different signal intensities. In general, those patients do not pose problems in differential diagnosis. New sequence developments and higher magnetic field gradients should be able to increase spatial resolution and decrease problems from motion artifacts. Studies with larger patient groups and sequences that quantify the results with ADCs are the necessary next steps.