OBJECTIVES: New adjacent spinal compression fractures occur not only in patients with osteoporotic spinal compression fractures after vertebroplasty but also in untreated old spinal compression fractures. The objective was to analyze and compare the characteristics in a group who had untreated old osteoporotic spinal compression fractures with those who had adjacent spinal compression fractures, which occurred after a vertebroplasty. MATERIALS & METHODS: From April 2006 to April 2009, 103 patients who had undergone vertebroplasty were evaluated. Eighteen patients (22 cases) who had untreated old osteoporotic spinal compression fractures were in group I, and 12 patients (13 cases) who had adjacent spinal compression fractures, which occurred after a vertebroplasty were in group II. In each group, we measured age and gender, body mass index (BMI), lumbar bone marrow density (BMD), sagittal index, and compression rate at the initial fracture site. RESULTS: The mean age of group I was 76.7-years-old (males/females: 5/13), and that of group II was 78.7-years-old (males/females: 6/6). The most common fracture site was T12 (36%) in group I, and the most common site was L1 (54%) in group II. The mean BMI of group I was 23.3 and that in group II was 19.8. The mean t-score of group I was -4.59 and that of group II was -3.99. The mean compression rate and sagittal index of group I was 30.7% and 24.5degrees, respectively and those in group II were 32.1% and 26degrees, respectively. No differences in sagittal index or compression rate were observed between the two groups. CONCLUSIONS: Patients require continuous education, exercise, and osteoporotic medication after an osteoporotic spinal compression fracture. In particular, after a vertebroplasty, patients must wear an orthosis, and in elderly patients with a low BMD, it is important to continually observe for an adjacent spinal compression fracture.