PURPOSE: The purpose of this study was to evaluate the effect of the kV on fractal dimension of trabecular bone in digital radiographs. MATERIALS AND METHODS: 16 bone cores were obtained from patients who had taken partial resection of tibia due to accidents. Each bone core along with an aluminum step wedge was radiographed with an occlusal film at 0.08 sec and with the constant film-focus distance (32 cm). All radiographs were acquired at 60, 75, and 90 kV. A rectangular ROI was drawn at medial part, distal part, and the bone defect area of each bone core image according to each kV. The directional fractal dimension was measured using Fourier Transform spectrum, and the anisotropy was obtained using directional fractal dimension. The values were compared by the repeated measures ANOVA. RESULTS: The fractal dimensions increased along with kV increase (p<0.05). The anisotropy measurements did not show statistically significant difference according to kV change. The fractal dimensions of the bone defect areas of the bone cores have low values contrast to the non-defect areas of the bone cores. The anisotropy measurements of the bone defect areas were lower than those of the non-defect areas of the bone cores, but not statistically significant. CONCLUSION: Fractal analysis can notice a difference of a change of voltage of x-ray tube and bone defect or not. And anisotropy of a trabecular bone is coherent even with change of the voltage of x-ray tube or defecting off a part of bone.