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OBJECTIVE To investigate the diagnostic value of single photon emission computed tomography/computed tomography (SPECT/CT) bone imaging in fresh osteoporotic vertebral compression fractures. MATERIALS AND METHODS The imaging data of 30 patients with osteoporosis (10 males and 20 females; aged 50~93 years) who received SPECT/CT bone imaging and spinal magnetic resonance imaging (MRI) in our hospital from June 2018 to June 2021 were analyzed retrospectively. Single photon emission tomography/CT bone imaging and spinal MRI were analyzed by two experienced specialists. Kappa consistency test and pairing were used for the diagnostic results of the two groups χ2 test (McNemar test) for statistical analysis. RESULTS Fifty one vertebral fractures were detected in 30 patients, including 41 fresh vertebral fractures and 10 old vertebral fractures by SPECT/CT bone imaging; MRI revealed 40 fresh vertebral fractures and 11 old vertebral fractures. Single photon emission tomography/CT bone imaging and spinal MRI had good consistency in the diagnosis of fresh osteoporotic vertebral compression fractures (Kappa=0.820, P<0.001), and there was no significant difference between the two imaging methods in the diagnosis of osteoporotic vertebral fractures (P=1.000). CONCLUSION The value of SPECT/CT in the localization and characterization of osteoporotic fresh vertebral compression fractures is similar to that of MRI. At the same time, SPECT/CT can also find some bone lesions that cannot be displayed by conventional MRI. Especially when patients have MRI contraindications, SPECT/CT bone imaging can be used as the preferred imaging method.