Following　primary　fractures　and　percutaneous　kyphoplasty　(PKP),　patients　have　a　high　risk　of　incurring　a　sub-sequent　vertebral　fracture　(SVF).　Given　that　SVF　is　a　consequence　of　mechanical　deterioration　of　the　vertebra,　we　sought　to　examine　whether　vertebral　strength　derived　from　QCT-based　finite　element　analysis　(i.e.,　BCT)　can　predict　the　risk　of　SVF.　Sixty-six　patients　who　underwent　PKP　were　categorized　into　two　groups:　control　or　non-SVF　group　(age:　70　+/-　7　years;　n　=　40)　and　SVF　group　(age:　69　+/-　8　years;　n　=　26).　BCT　was　performed　on　L4　or　L3　vertebrae　to　noninvasively　measure　vertebral　strength.　Vertebral　strength　was　also　estimated　based　upon　the　geometry　and　material　properties　of　the　vertebra.　Additionally,　trabecular　volumetric　bone　mineral　density　(vBMD)　and　L1　Hounsfield　unit　(HU)　were　measured.　t-Test,　chi　2　test　or　Mann　Whitney　U　test　were　used　to　compare　differences　in　these　parameters　between　the　two　groups.　The　predictive　abilities　of　BCT　strength　and　other　measured　parameters　were　evaluated　using　the　receiver　operating　characteristic　(ROC)　analysis.　Results　showed　no　significant　difference　in　either　vBMD　or　L1　HU　between　the　control　and　SVF　groups　(p　＞　0.05),　whereas　BCT-computed　and　estimated　vertebral　strength　values　were　significantly　reduced　by　33　%　and　24　%　for　the　SVF　group　relative　to　the　non-SVF　group,　respectively.　ROC　curve　indicated　that　BCT　strength　had　the　largest　area　under　the　curve,　compared　to　other　parameters.　These　results　suggest　that　BCT-computed　vertebral　strength　may　serve　as　a　surrogate　for　assessing　risk　of　SVF.