Objective To identify risk factors for failure of conservative treatment of osteoporotic vertebral compression fracture(OVCF).Methods From January 2019 to December 2021，150 patients who underwent conservative treatment were enrolled in Xi’an Jiaotong University Affiliated Honghui Hospital.Poor pain relief was defined by a visual analogue scale(VAS)≥4 after 3 weeks of regular conservative treatment，and patients were divided into conservative treatment effective and ineffective groups according to the degree of pain relief.The conservative treatment effective group(n=92) had 31 male and 61 female patients.The patients were aged 60 to 84 years，with a mean age of (69.5±5.3) years.The ineffective group(n=58) had 17 male and 41 female patients.The patients aged 62 to 94 years，with a mean age of (74.9±6.5) years.The basic demographic data (gender，age，body mass index)，basic disease history (diabetes，hypertension，depression)，bone mineral density (BMD)，localized high signal or diffuse low signal findings on magnetic resonance imaging (MRI) T₂ weighted (T₂WI)，and dynamic fracture mobility were recorded in the two groups.Univariate analysis was used to analyze the correlation between the above parameters and conservative treatment failure.Independent risk factors for failure of conservative treatment were then identified by multivariate logistic regression analysis.Results Among the 150 patients，58(38.7%) failed to respond to conservative treatment.Univariate analysis showed that age，BMD，overweight，localized high signal or diffuse low signal findings on MRI-T₂WI，and dynamic fracture mobility were associated with conservative treatment failure (all P＜0.05).After multivariate analysis，age(OR=1.133，P＝0.003)，BMD (OR=5.297，P＝0.018)，overweight(OR=3.267，P＝0.006)，dynamic fracture mobility(OR=3.623，P＝0.007)，localized high signal or diffuse low signal findings on MRI-T₂WI (OR=3.868，P＝0.003)and combined with depression (OR=3.552，P＝0.047)were independent factors influencing the outcome of conservative treatment.The receiver operating characteristic(ROC) analysis showed that the critical values of age and bone mineral density were 72.5 years old and －3.3.Conclusion Patients with OVCF have a high rate of conservative treatment failure.Advanced age，low bone density，overweight，localized high signal or diffuse low signal findings on MRI-T₂WI，dynamic fracture mobility and combined with depression are independent risk factors for failure of conservative treatment.Conservative treatment is not recommended for patients aged > 72.5 years or BMD < -3.3.