As the Middle Ages progressed, altarpieces began to be commissioned more frequently. In Northern Europe, initially Lübeck and later Antwerp would develop into veritable export centres for the production of altarpieces, exporting to Scandinavia, Spain and northern France. By the 15th century, altarpieces were often commissioned not only by churches but also by individuals, families, guilds and confraternities. The 15th century saw the birth of Early Netherlandish painting in the Low Countries; henceforth panel painting would dominate altarpiece production in the area. In Germany, sculpted wooden altarpieces were instead generally preferred, while in England alabaster was used to a large extent. In England, as well as in France, stone retables enjoyed general popularity. In Italy both stone retables and wooden polyptychs were common, with individual painted panels and often (notably in Venice and Bologna) with complex framing in the form of architectural compositions. The 15th century also saw a development of the composition of Italian altarpieces where the polyptych was gradually abandoned in favour of single-panel, painted altarpieces. In Italy, during the Renaissance, free-standing groups of sculpture also began to feature as altarpieces. In Spain, altarpieces developed in a highly original fashion into often very large, architecturally influenced reredos, sometimes as tall as the church in which it was housed.

Large number of altarpieces are now removed from their church settings, and often their elaborate sculpted frameworks, and displayed as more simply framed paintings in museums and other places.

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