The purpose of this study was to report a patient with osteoporotic vertebral compression fracture (OVCF) which was misdiagnosed as metastatic vertebral compression fracture (MVCF). A 64-year male was admitted to our clinic for complaints of numbness, pain, and activity limitation in bilateral lower extremities. One year ago, he had a medical history of lung adenocarcinoma and bone metastasis. A month ago, he developed back pain and lower-limb paralysis. X-ray, computer tomography (CT), and magnetic resonance imaging (MRI) showed thoracic 11 (T11) vertebral compression fracture. Furthermore, emission computed tomography (ECT) indicated MVCF preoperatively. However, the histopathology findings suggested OVCF postoperatively. Consequently, the patient was discharged without chemoradiotherapy. During the 14-months follow-up period, no relapsed spinal neoplasm or recurrence of vertebral fracture was observed. In conclusion, OVCF in patients with a history of lung cancer is easily misdiagnosed as MVCF. It is important to differentiate OVCF from MVCF by clinical symptoms, laboratory examination, and imaging features before operation. Histological findings are the gold standard for accurate diagnosis. Key Words: Osteoporosis, Vertebral fracture, Metastasis.