Health-status and preference-based approaches to assessing health-related quality of life (HR-QOL) in osteoporosis are reviewed. Osteoporosis-targeted health-status instruments [i.e. Osteoporosis Quality-of-Life Questionnaire (OQLQ), Osteoporosis Assessment Questionnaire (OPAQ), Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO), Osteoporosis-Targeted Quality-of-Life Questionnaire (OPTQoL), Osteoporosis Functional Disability Questionnaire (OFDQ), Quality-of-Life Questionnaire in Osteoporosis (QUALIOST)], which have been utilised to document the adverse impact of osteoporosis on HR-QOL in diverse clinical and epidemiological studies, are described first. Preference-based approaches to osteoporosis health-outcome measurement are then considered in both clinical and health policy settings. In the clinical setting, direct preference assessments [i.e. visual analogue scale (VAS), time tradeoff (TTO), standard gamble (SG)] using either experienced or described health outcomes have consistently shown significantly lower values for osteoporosis-related health states relative to usual or ideal health. In the health-policy context, preference-classification systems [i.e. EuroQoL (EQ-5D), Health Utilities Index (HUI)] for valuing health in economic studies are reviewed. At present, there is little evidence to guide the choice of one system over another for assessing the cost effectiveness of osteoporosis interventions; however, use of a consistent set of health-state values is essential. Further research is needed to characterise associations between osteoporosis-targeted health-status instruments and preference-based health-outcome measures. In addition, the longitudinal impact of osteoporosis and related fractures on HR-QOL must be documented.