〔Abstract〕 Objective To investigate the risk factors of adjacent vertebral fractures secondary to vertebral augulation in patients with single-segment thoracolumbar osteoporotic vertebral compression fracture (OVCF). Methods A retrospective analysis was performed on the clinical data of 370 patients with single-segment thoracolumbral OVCF treated by vertebral augplasty in the First Affiliated Hospital of Guilin Medical University from January 2016 to January 2021. The influencing factors of postoperative adjacent vertebral fractures were evaluated by logistic regression according to whether there were adjacent vertebral fractures. Results Of the 370 patients, 44 had fractures of adjacent vertebral bodies, with an average fracture time of (5.79 ± 1.51) months. Univariate analysis showed that there were statistically significant differences between the adjacent vertebral fracture group and the group without adjacent vertebral fracture in age, postoperative bone cement leakage, systemic anti-osteoporosis treatment, bone cement injection amount, recovery rate of injured vertebrae and preoperative bone mineral density (P < 0.05). Multivariate logistic regression analysis showed that age ≥ 80 years, inability to receive systematic anti-osteoporosis treatment, postoperative bone cement leakage and low preoperative bone mineral density were independent risk factors for postoperative adjacent vertebral fracture (P < 0.05). ConclusionThe risk of adjacent vertebral fractures in patients with single-segment thoracolumbar OVCF treated with vertebral augmentation was closely related to patient age, systemic anti-osteoporosis treatment, postoperative bone cement leakage, and preoperative bone mineral density. For older patients with low bone mineral density, postoperative bone cement leakage, and those who have not received systematic anti-osteoporosis treatment in the past, clinical intervention should be strengthened to avoid the occurrence of adjacent vertebral fractures.