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Introduction: The risk of osteoporotic vertebral refracture (OVRF) is substantially increased after initial osteoporotic vertebral fracture (OVF). In this study, we comprehensively analyzed risk factors for OVRF in patients undergoing conservative treatment and further evaluated the predictive value of various risk factors. Methods: Basic information, past medical history and imaging parameters were collected from 151 postmenopausal OVFwomen treated conservatively. In univariate analysis, chi-square testwas used for categorical variables and independent sample t-test was used for continuous variables. Binary logistic regression was used to identify independent risk factors for variables with significant differences in univariate analysis. Then receiver operating characteristic curve analysis (ROC Curve) were drawn for the predictors and area under the curve (AUC) were calculated to evaluate the prediction accuracy. Results: Univariate analysis and binary logistic regression analysis showed that age (p < 0.05) and L3/4 paraspinal muscle fat infiltration ratio (FIR) (p < 0.05) were independent risk factors of OVRF. According to the ROC curve, the prediction accuracy of age, FIR and the two parameters together were 0.730, 0.778 and 0.813 respectively. The critical values of age and FIRwere 63.5 years and 37.1%, respectively. Conclusion: OVRF is affected by multiple factors. Age and FIR are independent risk factors of OVRF. The prediction value of integrated two independent risk factors was higher than that of a single risk factor. Postmenopausal women with initial OVF aged over 63.5 years and FIR over 37.1% were more likely to develop OVRF. [ABSTRACT FROM AUTHOR]