Vertebral compression fractures may occur due to benign or malignant conditions. This may constitute a diagnostic challenge in elderly population particularly with history of primary malignancy.DW MRI has been proven to be a highly useful method for the differential diagnosis of acute osteoporotic and neoplastic vertebral compression fractures. Diagnosis is based on the contrast to normal bone marrow. Hypo- or isointensity reflects acute benign collapse, while, hyperintensity is indicative of the tumorous nature of a fracture.