Osteoporosis is a disease characterized by reduced amount of bone mass leading to enhanced bone fragility. The number of patients with osteoporotic vertebral fracture is increasing and it is one of the leading causes of morbidity in the elderly. This study was performed to find the relationship between bone mineral density (BMD) and osteoporotic vertebral fracture, to determine the incidence of vertebral fracture in the elderly and to evaluate the efficacy of calcitionin derivative on back pain in patients with osteoporotic vertebral fracture. The authors performed BMD measurement(L2-L4) using DEXA, T spine and L-S spine roentgenograms in 114 patients, all above 50 years, visited orthopedic Department of Seoul National University Hospital from Octover, 1991 to May, 1992. Among 114 cases, 24cases (21%) had vertebral fracture associated with osteoporosis. The incidence of osteoporotic vertebral fracture(22 out of 70 cases) in female was much higher than that of male (2 out of 44 cases). The mean BMD (L2-L4) of vertebral fracture cases were lower than that of same age group and we could not find vertebral fracture in cases with BMD (L2-L4) above 0.9g/cm2. Fracture threshold (90 percentile) was estimated as 0.74g/cm2. The first lumbar vertebra was the most common fracture site and 12 cases showed multiple vertebral fracture. In patients with vertebral fracture, 10 cases (42%) had minor trauma history. All of them complained varying degrees of back pain and after average 4 months of Elcatonin injection, 22 cases (92%) out of 24 cases showed improvement of back pain. In conclusion, the incidence of osteoprotic vertebral fracture is higher in female, in older age group and related with low BMD. The main symptom of osteoporotic vertebral fracture is back pain and it is effectively managed with Elcationin.