Background <p>Obesity and osteoporosis frequently coexist. Assessing them separately can miss obesity-related bias in lumbar aBMD and fragility driven by impaired bone quality. To deliver a practical, scenario-based “one-stop-shop” that simultaneously characterizes adiposity and bone status.</p> Methods <p>Narrative review framed by PICO. We searched the MEDLINE, PubMed, Scopus, and Web of Science databases to evaluate various imaging modalities for obesity and osteoporosis, as well as their feasibility for “one-stop-shop”.</p> Results <p>Pathophysiologically, expansion of bone-marrow adipose tissue, adipokine/hormonal dysregulation, and mesenchymal stem-cell adipogenic shift, reduces bone mass. Clinically, the feasibility of mainstream imaging techniques for “one-stop-shop” is evaluated: As diagnostic tools, QCT and DXA cater precisely to the requirements of clinical diagnosis, providing reliable evidence for disease confirmation. As screening tools, both perform exceptionally well; among them, DXA, with its distinct advantages of lower radiation exposure and cost-effectiveness, is particularly suited for large-scale preliminary screening of populations. Additionally, DECT, MRI, and ultrasound can serve as effective supplementary tools, enhancing the comprehensive assessment of bone health and obesity.</p> Conclusions <p>This review focuses on the field of obesity-osteoporosis comorbidity. It deconstructs the interaction between the two conditions at the pathophysiological and clinical levels, explores the characteristics of high-risk populations, and examines the feasibility of the “one-stop-shop”. Bone mass and fat data acquired through “one-stop-shop” provide a more comprehensive and accurate reflection of adiposity and bone status, enabling clinicians to formulate targeted intervention strategies.</p>