OBJECTIVE: With the development of an aging society in China, osteoporotic spinal compression fractures are occurring more and more in the elderly. The diagnosis and treatment of osteoporotic spinal compression fractures in the elderly are also receiving increasing attention. The purpose of this study was to analyze how to improve the diagnosis rate of osteoporotic spinal compression fractures by history, X-ray and MRI in elderly patients. METHODS: A total of 121 patients with osteoporotic spinal compression fractures were diagnosed and treated in the outpatient and inpatient orthopedic departments of Beijing Hospital from January 2000 to December 2007. There were 48 male cases and 73 female cases. The age ranged from 61 to 92 years, with an average of 73.5 years. All patients were asked in the outpatient clinic if there was any history of no apparent cause, falls, straining while bending, sneezing, lifting heavy objects such as flower pots, etc. The nature of spinal pain was asked, such as pain in changing position, pain in seating, pain in standing or pain in lying down. The presence or absence of abdominal distension was recorded at the same time. All patients received X-ray frontal and lateral examinations and MRI examinations of the corresponding areas, and two of them underwent isotope bone scan examination because they could not receive MRI examination. Positive rates of MRI or bone scan in plain X-ray apparent vertebral compression fractures were used to determine whether the fractures were fresh or old. The positive rate of diagnosis of osteoporotic spinal compression fractures in the elderly by plain X-ray was judged by the positive finding of MRI or bone scan. RESULTS: Only 68 (56.2%) of the 121 patients in this group had an obvious cause for the fall. 34 (30.4%) cases did not find any cause. There were 46 cases of compression fracture of the lumbar spine alone, 65 cases of compression fracture of the thoracic spine alone, and 10 cases of fracture of both the thoracic and lumbar spine. 115 patients in about 95% of the cases presented with spinal pain when changing positions, such as from lying to seated or from seated to standing. The number of cases with abdominal distension was 33, all of which were lumbar compression fractures, accounting for 58.9% of lumbar compression fractures. 98 (69.5%) of the 141 vertebral compression fractures showing significant compression fractures on X-ray with a positive MRI fat suppression image high signal represented fresh fractures, and another 43 (30.5%) vertebral MRI fat suppression images without high signal indicated old fractures. 121 cases with MRI fat X showed significant compression changes in 97 of 127 vertebrae with high signal on suppression images or positive findings on bone scan, and X-rays of another 30 (23.6%) vertebrae were not diagnostic of significant compression fractures. Conclusion: A significant proportion of osteoporotic spinal compression fractures in the elderly have no clear history of falls, and the presence of spinal pain on change of position is a clinical feature of the disease. The diagnosis of fractures relies on X-rays in addition to more importantly MRI in order to reduce missed diagnoses and determine the newness of the fracture. It is not uncommon to have symptomatic intravertebral microfractures (without compression changes).