Summary <p>This study aimed to identify factors influencing the development of segmental kyphosis development and new compression fractures in Osteoporotic Vertebral Compression Fractures (OVCF)in postmenopause women. We found fatty infiltration (FI) of the multifidus and erector spinae, high BMI, was risk of segmental kyphosis development following OVCF.</p> Background <p>Paraspinal muscles play a crucial role in maintaining sagittal balance and seem to associated with kyphosis after OVCF. However, there have been few studies investigating the factors associated with the development of segmental kyphosis development after conservative treatment OVCF in postmenopausal women. We aim to identify factors influencing the development of segmental kyphosis development after conservative treatment and the occurrence of new compression fractures.</p> Methods <p>Postmenopausal women diagnosed with OVCF and managed conservatively at the author's clinic from 2012 to 2022 were retrospectively analyzed. All patients were followed up for more than 1 year and completed imaging studies. In this study, patients were divided into three groups according to the degree of segmental kyphosis development and two groups based on the presence of the newly developed compression fractures. To identify factors associated with the segmental kyphosis development and newly developed compression fractures, by comparing demographic data, radiologic data, MRI assessments, and Koval grades across the groups. </p> Results <p>A total of 200 postmenopausal women were included, with 87 in Grade 1, 78 in Grade 2, and 35 in Grade 3. Higher body mass index and higher FI in erector spinae and multifidus muscles significantly correlated with segmental kyphosis development (p-value&gt;0.05). No significant differences in newly developed compression fractures.</p> Conclusion <p>High FI of the multifidus and erector spinae, along with high BMI, is associated with the development of segmental kyphosis development following OVCF.</p>