Objectives <p>To assess the predictive value of lumbar intervertebral disc degeneration (IVDD) in determining new vertebral fracture (NVF) after vertebral augmentation (VA) within 2 years for patients with osteoporotic vertebral compression fracture (OVCF) and develop the NVF score system for preoperative prediction of NVF.</p> Methods <p>Patients with painful OVCF and VA were divided into two groups according to whether NVF occurred within 2 years after VA. Preoperative lumbar magnetic resonance imaging was used to evaluate IVDD depending on Pfirrmann grade. Multivariable regression analysis was used to select independent predictors for imminent NVF. Scores were assigned to each predictor based on the regression coefficient and the NVF score system was established. The predictive performance was assessed by area under the curve (AUC), sensitivity, and specificity for each score cutoff.</p> Results <p>A total of 186 patients (71.7 ± 8.5 years; 157 females; 76 NVF) were included. The prevalence of multi-level severe lumbar IVDD in the NVF group was higher than in the group without-NVF (<i>P</i> &lt; 0.001). Age &gt; 76 years (OR = 2.178, 95% Cl = 1.025–4.628, <i>P</i> = 0.043), previous vertebral fracture (OR = 2.719, 95% Cl = 1.350–5.477, <i>P</i> = 0.005), BMD &lt; 50.6&#xa0;mg/cm³ (OR = 2.557, 95% Cl = 1.209–5.411, <i>P</i> = 0.014), and multi-level lumbar severe IVDD (OR = 2.291, 95% Cl = 1.051–4.996, <i>P</i> = 0.037) were independent predictors of NVF, forming the four-point NVF score system with an AUC of 0.770 (95% Cl = 0.702–0.837). The score cut-off of &gt; 0, 1, 2, and 3 predicted NVF with sensitivities of 94.7%, 82.9%, 55.3%, and 22.7%, respectively, and specificities of 34.6%, 58.2%, 80.0%, and 98.2%.</p> Conclusions <p>Age &gt; 76 years, previous vertebral fracture, BMD &lt; 50.6&#xa0;mg/cm³, and multi-level severe lumbar IVDD, composing the NVF score system, can predict imminent NVF after VA in patients with OVCF.</p>