Purpose: In an aging human population, vertebral compression fractures (VCFs) are frequently encountered, particularly in female, and the prevalence of sarcopenia is also high. This study analyzed the clinical characteristics of elderly female with sarcopenia and the relationship between vertebral sagittal spinal–pelvic parameters and osteoporotic VCFs. Materials and Methods: The database was searched retrospectively for 157 female aged 60 years or older who visited the Gachon University Gil Medical Center from October 2021 to September 2022. The subjects were divided into a VCF group (58 patients, 36.9%) and a non-fracture group (99 patients, 63.1%). The clinical characteristics, including age, body mass index (BMI), bone mineral density (BMD), relative skeletal muscle index (RSMI, sarcopenia<5.45 kg/m2 ), and sagittal spinopelvic parameters in the two groups were compared. Results: Patients with sarcopenia had a 2.94-fold higher risk of developing VCF compared to those without sarcopenia (odds ratio=2.94, p=0.009). In addition, the risk of VCF increased as the RSMI decreased (odds ratio=1.24, p=0.012). The RSMI showed significant associations with age, BMI, BMD, and sagittal spinopelvic parameters, including T1 pelvic angle (TPA), sagittal vertical axis, sacral slope, lumbar lordosis, and thoracic lumbar kyphosis. Multivariate regression analysis for VCF, RSMI, sarcopenia, and TPA showed significant results alongside BMI and BMD. Conclusion RSMI is an important indicator for diagnosing sarcopenia and can serve as a potential factor for predicting the risk of VCF.