Objective To analyze the characteristics of X-ray and MRI imaging features of primary osteoporotic vertebral compression fractures. Methods One hundred patients with vertebral compression fracture in our hospital between June 2010 to January 2016 were studied and 56 cases with the primary osteoporotic vertebral compression fractures were chosen as the observation group which received X-ray, MRI. Forty-two cases with vertebral compression fracture secondary to metastatic tumor were chosen as the control group which all underwent MRI examination but 15 cases underwent X-ray examination. The X-ray, MRI features of the fracture between the two groups were observed and compared. Results X-ray image characteristics: observation group detected 70 cases with vertebral fracture, the vertebral body were mainly depressed shape and it account for 65.71%, the vertebral bone mineral density decreased, accounting for 95.71%, spinal deformation for 11.43%, the fracture involving the endplate for 31.43%, control group detected 22 cases with vertebral fracture and vertebral morphology were wedge compression mainly, accounting for 54.55%, secondly is concave, 31.82%, the osteolytic type for 81.82%, spinal stenosis for 18.18%, with the involving endplate 40.91%. MRI features: the observation group showed vertebral angle or corner after alice was 97.14%, T1WI showed 27 localized low signal, T2WI fat suppression sequences showed high signal in 41 cases, control group showed 96.15% of the cases with dome shaped vertebral body, 38 cases with irregular nodular paravertebral soft tissue mass. T1WI showed fracture lesions diffuse low signal in 43 cases. T2WI fat suppression sequences showed 48 cases high signal, the enhanced scanning showed obvious enhancement. Conclusion X-ray and MRI have important value in the differential diagnosis of primary osteoporosis and vertebral compression fractures secondary to metastatic tumor.