RATIONALE AND OBJECTIVES: New vertebral compression fractures (NVCF) are very common in patients following percutaneous vertebroplasty (PVP) or kyphoplasty (PKP). The study aims to evaluate the comparative predictive performance of vertebral bone quality (VBQ) score and Hounsfield units (HU) value in forecasting NVCF after surgery. MATERIALS AND METHODS: This study retrospectively analyzed patients who underwent PVP/PKP at our institution between 2020 and 2021. The VBQ score and HU value were obtained from preoperative magnetic resonance imaging (MRI) and computed tomography (CT) scans, respectively. Subsequently, the forecasting capabilities of these two parameters were assessed by contrasting their receiver operating characteristic (ROC) curve. RESULTS: A total of 303 eligible patients (56 with NVCF and 247 without) were identified in the study. Six relevant literature factors were identified and included in the multivariate analysis revealed that lower HU value (OR = 0.967, 95% CI = 0.953-0.981, P <
0.002) and higher VBQ score (OR = 3.964, 95% CI = 2.369-6.631, P <
0.002) emerged as independent predictors of NCVF occurrence. Compared to the ROC curve of the HU value, demonstrating a diagnostic accuracy of 83.2% (95% CI = 77.5%-88.9%, P <
0.002), the VBQ score was 85.8%. And, a statistically significant negative correlation was observed between the VBQ score and the T-score (r = -0.529, P <
0.002). CONCLUSION: In patients undergoing PVP/PKP, VBQ score, and HU value are independently associated with the occurrence of NVCF. Assessing the HU value and the VBQ score could play an effective role in planning PVP/PKP operations.