OBJECTIVE: To evaluate the feasibility of determining the target vertebral body (TV) of uncompressed elderly osteoporotic thoracolumbar fractures through measuring Hounsfield unit (HU) value. PATIENTS AND METHODS: Elderly patients with osteoporotic thoracolumbar fractures aged above 65 years old hospitalized from 2015 to 2016 were retrospectively analyzed. The cases whose TV could not be determined by computed tomography (CT) imaging but confirmed by magnetic resonance imaging (MRI) were selected. The mean HU values of the trabecular bone regions of TV and adjacent vertebral body in the multi-detector CT (MDCT) sagittal three-dimensional reconstructed image were measured and compared. At the same time, 60 thoracolumbar adjacent vertebral bodies without fractures were selected from 20 people, and the mean HU value of the trabecular bone region of each vertebra in the MDCT sagittal three-dimensional reconstructed image was measured and compared. RESULTS: There were correlations among the mean HU values of 60 thoracolumbar adjacent vertebral bodies in the 20 people without fractures, and there were no differences in the correlations between middle vertebral body (MV) and upper vertebral body (UV) and between MV and lower vertebral body (LV) compared with the correlation between UV and LV. In the 31 fracture cases, the mean HU values had correlations among TV, UV and LV, there was no difference in the comparison of correlations between TV and UV and between TV and LV, but the correlations between TV and UV and between TV and LV had differences compared with the correlation between UV and LV. CONCLUSIONS: The mean HU value of TV of uncompressed elderly osteoporotic thoracolumbar fractures is increased abnormally compared with that of the adjacent vertebral body, and it is feasible to determine the TV of uncompressed osteoporotic thoracolumbar fractures according to the mean HU value.