The charts and radiographs of 70 patients older than 50 years of age with thoracic vertebral body collapse were reviewed retrospectively. Fifteen patients had traumatic fractures and 34 had osteoporotic collapse of thoracic vertebrae. Metastasis was the underlying disease process in 18 patients and multiple myeloma in the remaining 3 patients. Thirteen patients had fractures involving the upper half of the dorsal spine, of which 8 (61.5%) were metastatic, 4 (30.8%) osteoporotic, and 1 (7.7%) traumatic. All patients with osteoporotic fractures of the upper dorsal spine also had 1 or more fractures of the lower dorsal or lumbar spine. There were 11 metastatic, 80 osteoporotic, 14 traumatic, and 3 fractures secondary to multiple myeloma involving the lower dorsal spine. There were no infections or primary bone tumors. The difference in the frequency of metastatic fractures against other etiologies involving the upper versus the lower thoracic spine was highly statistically significant.