Osteopenia is a potential prognostic factor in patients with cancer. Occult vertebral fracture, the most common complication of osteopenia, has recently been associated with cancer. The present study aimed to investigate the prognostic value of occult vertebral fracture after gastrectomy in patients with gastric cancer. The current retrospective study included 222 patients who underwent gastrectomy for gastric cancer between October 2013 and February 2023. Occult vertebral fracture was quantitatively evaluated using preoperative sagittal computed tomography images from the 11th thoracic to 5th lumbar vertebrae. Multivariate analysis showed that occult vertebral fracture (P<
0.01, P=0.02, respectively), stage II or III (P<
0.01, P<
0.01, respectively), and R1 or R2 curability (P<
0.01, P=0.03, respectively) were independent and significant predictors of disease-free and overall survival rates. Additionally, patients with both occult vertebral fracture and osteopenia had significantly lower disease-free and overall survival rates than those with either osteopenia or occult vertebral fracture (P<
0.01, P<
0.01, respectively). In conclusion, occult vertebral fracture may be considered a strong predictor of poor clinical outcomes in patients undergoing gastrectomy for gastric cancer.