【Abstract】 Objective To explore the diagnostic value of improved Computed Tomography (CT) window technology in differentiating fresh from old osteoporotic vertebral compression fractures. Method A total of 90 patients (215 abnormal vertebrae) with osteoporotic vertebral compression fractures diagnosed by Magnetic Resonance Imaging (MRI) in Puyang Traditional Chinese Medicine Hospital from January 2020 to January 2024 were selected as the research subjects. conventional CT window and improved CT window technologies were performed, and MRI examination was used as the gold standard. The efficacy of the two examination technologies in distinguishing between new and old osteoporotic vertebral compression fractures was compared, and the image interpretation time was compared. Result The image interpretation time of conventional CT window technology was (103.49 ± 11.71)s, which was higher than that of the improved CT window technology (56.97 ± 8.49) s (t=30.512, P ＜ 0.001); MRI showed 79 fresh fractured vertebrae and 136 old fractured vertebrae; The conventional CT window technology showed 65 fresh fractured vertebral bodies and 150 old fractured vertebral bodies. The sensitivity, specificity of diagnosing fresh osteoporotic vertebral compression fractures were 75.95%, 96.32%, respectively. The Kappa coefficient test showed a Kappa value of 0.751 (P=0.047). The improved CT window technology revealed 77 fresh fractured vertebral bodies and 138 old fractured vertebral bodies. The sensitivity, specificity of diagnosing fresh osteoporotic vertebral compression fractures were 96.20%, 99.26%, respectively. The Kappa coefficient test showed a Kappa value of 0.960 (P=0.020).Conclusion Improved CT window can improve the diagnostic efficiency of distinguishing fresh osteoporotic vertebral compression fractures, with high consistency with MRI and the advantage of shorter image interpretation time.