Osteoporosis　is　characterized　by　decreased　bone　strength　and　increased　fracture　risk.　The　most　serious　consequence　of　osteoporosis　is　fracture,　which　commonly　occurs　in　vertebrae.　Accurate　assessment　of　fracture　risk　at　an　earlier　stage　is　the　key　to　identify　high-risk　population　and　further　prevent　osteoporotic　fracture.　Currently,　clinical　assessment　of　vertebral　fracture　risk　mainly　relies　on　measurement　of　bone　mineral　density　(BMD)　based　on　dual　energy　X-ray　absorptiometry　(DXA)　or　quantitative　computed　tomography　(QCT).　However,　they　cannot　fully　reflect　bone　strength　and　resistance　to　fracture,　and　it　is　hard　to　achieve　an　accurate　assessment.　Biomechanical　CT　(BCT)　technology,　based　on　CT　digital　modeling　and　finite　element　analysis,　aims　at　non-invasive　calculation　of　individual　bone　strength,　bridging　the　gap　between　biomechanics　and　clinical　evaluation　of　fracture　risk.　In　vitro　mechanical　experiment　of　vertebrae　has　proved　that　BCT　is　more　accurate　than　BMD　in　evaluating　vertebral　fracture　strength.　Clinical　studies　have　also　shown　that　BCT　is　superior　to　DXA　in　identifying　existing　fractures　and　predicting　new　fractures.　In　this　article,　the　implementation　process　of　the　BCT　technology　was　introduced,　as　well　as　critical　parameters　during　each　step　affecting　its　results.　The　research　progress　of　the　BCT　technique　for　in　vitro　validation　and　in　vivo　assessment　of　vertebral　fracture　risk　was　also　summarized,　with　the　aim　to　promote　the　application　of　BCT　technology　in　clinical　assessment　of　vertebral　fracture　risk　for　the　Chinese　people.　©　2023　Shanghai　Jiaotong　University　School　of　Medicine.　All　rights　reserved.