Background: In the patients with osteoporotic vertebral Compression fracture (OVCF) treated conservatively, significant progressionof the local kyphosis due to an impaired healing leads to reduction in the quality of life. Thus, it is of critical value to identifythe predictors of this major complication. Objectives: The current prospective cohort study aimed at evaluating the predictors of progression in the local kyphosis in a seriesof patients with acute OVCF undergoing conservative treatment. Methods: Eligible patients with OVCF were identified and local kyphosis progression was evaluated after four months of conservativetreatment. Demographic characteristics such as gender, age, and body mass index (BMI), as well as radiographic characteristicssuch as the location of fracture, bone mineral density (BMD), andserum25 (OH) vitaminDlevel were compared between the patientswith local kyphosis angle (LKA) progressed 30° (group A) and the patients with LKA remained < 30° (group B). Results: From a total of 60 patients with OVCF, LKA progressed 30° in 19 patients (31. 7%). The mean change of LKA was 16. 2° 7. 2° in group A and 1. 92° 2. 7° in group B (P < 0. 001). Higher age, lower BMI, and lower spinal BMD were significantly associatedwith LKA progression 30° (P = 0. 013, P < 0. 001, and P = 0. 037, respectively). The involvement of thoracolumbar junction (T11-L1)was more frequent in group A (P = 0. 049). Anterior cortical wall fracture was more frequent in group A as well (P = 0. 007). afteradjustment of confounding factors, the association of LKA progression with the age, BMI, and the level of fractured vertebra stillremained significant. Conclusions: Significant progression of LKA following conservative treatment of OVCF is correlated with the level of fractured vertebra, BMI, and age of the patients. These factors could be used to select patients most benefit from conservative treatment.