Purpose: To evaluate the sensitivity, specificity and accuracy of various magnetic resonance imaging (MRI) features in differentiating vertebral compression fractures caused by malignancy, osteoporosis, and infections. Methods: 35 men and 45 women aged 40 to 78 (mean, 59) years underwent MRI to assess the underlying pathology of already diagnosed vertebral compression fractures (n=152). The interval from presentation to imaging ranged from 7 to 95 (mean, 62) days. MRI features of each vertebral compression fracture were assessed. The sensitivity, specificity, and accuracy for each of the MRI features were calculated. Association between each MRI feature and various underlying pathologies (malignancy, osteoporosis, and infections) of vertebral compression fractures was evaluated. Resuts: Regarding these 80 patients, the MRI diagnosis was correct in 78 and inconclusive in 2 with malignancy. MRI features suggestive of malignant fractures were a convex posterior border of the vertebral body, pedicle involvement, posterior neural element involvement, an epidural mass, a paraspinal mass, and other spinal metastases. MRI features suggestive of osteoporotic fractures were retropulsion, low signal intensity band, spared normal marrow signal intensity, and the fluid sign. MRI features suggestive of infective fractures were contiguous vertebral involvement, end plate disruption, disc involvement, and paraspinal and epidural abscesses. Conclusion: Combination of several MRI features can provide clues to differentiate between malignant, osteoporotic, and infective vertebral compression fractures.