Background: Compression fractures are common among osteoporotic patients and can be a significant source of pain and disability. Patients who suffer a compression fracture are most often treated conservatively. Case Presentation: This report presents the case of an 80-year-old non-hypertensive, non-diabetic male who presented to the hospital with severe acute lower back pain for one week previous. There was no associated past history of trauma. Initially, the patient was misdiagnosed as a case of simple musculoskeletal lower back pain, for which he received treatment, but the pain intensified over the following two weeks, prompting consultation with a neurologist. A physical examination and lumber x ray indicated signs of lumbar spondylosis with degenerative disc disease, for which the patient was prescribed paracetamol and non-steroidal anti- inflammatory drugs. However, no improvement was noted. Later, after three weeks, an MRI investigation was conducted. The findings revealed multiple disc narrowing levels throughout the lumbar spine. Based on these investigations, treatment was initiated with pregabalin. Tramadol was discontinued and visible improvements in the patient's condition were noted within a week. Later, the patient sought consultation from an orthopedic specialist. The doctor recommended additional imaging scans. Magnetic resonance imaging with contrast and computerized tomography scans were performed. Based on these imaging scans, a diagnosis of lumbar spine scoliosis and osteoporotic compression fracture at D12 was made, prompting the initiation of osteoporosis treatment with zoledronic acid. Conclusions: Initial diagnosis and management of osteoporotic vertebral compression fractures are important in preventing continued pain and preserving the quality of life in older patients. This case highlights the need for comprehensive evaluation, including MRIs, to discriminate acute fractures from other pathologies, facilitating appropriate intervention and osteoporosis management.