The study investigated the diagnostic efficacy of a combination of CT and MRI in differentiating between benign and malignant vertebral compression fractures. From January 2020 to January 2025, 150 patients were included in the research, divided according to the pathological findings into a benign group (76 cases) and a malignant group (74 cases). All patients underwent MRI and CT examinations. There were significant differences in MRI features between the groups, such as degree of compression of the vertebral body, extent and location of lesions, post-compression tebrology, morphology of soft tissue and vertebral body, signal changes of veins of the vertebral body (P < 0.05). The apparent diffusion coefficient (ADC) value was higher in the benign group than in the malignant group (P < 0.01). Combined CT and MRI diagnostics achieved higher accuracy, sensitivity and specificity compared to individual methods (P < 0.05). The combination of MRI and CT thus demonstrated a high diagnostic value in identifying the nature of fractures.