Objective This study aimed to identify the risk factors for vertebral compression fractures in patients with osteoporosis. Methods A total of 864 patients with osteoporosis were enrolled in a retrospective study from February 2010 to June 2016. Patients with diseases, such as pathological fractures, high-energy direct injury to the thoracic or lumbar vertebrae, and severe spinal deformity, were excluded. The patients were divided into two groups: those with vertebral compression fractures (288) and those with no vertebral compression fractures (576). Information on the patients' age, sex, lumbar bone mineral density (BMD), trauma, body mass index, previous history of vertebral compression fractures, and spondylolisthesis was recorded. Logistic regression analysis and the chi-square test were applied for comparisons. Results Univariate logistic regression analysis and chi-square test results showed no significant differences in age, sex, body mass index, type 2 diabetes, previous history of vertebral fracture, and trivial trauma between the groups. Multivariate analysis showed significant associations between spondylolisthesis and BMD. Logistic regression analysis showed that spondylolisthesis and BMD were risk factors for vertebral compression fractures. Conclusions Lumbar spondylolisthesis is an independent risk factor for vertebral compression fractures in patients with osteoporosis. Therefore, patients with osteoporosis and lumbar spondylolisthesis require more attention.