To evaluate the effect of the presence of a vertebral fracture on balance and physical performance and its contribution to fall and fracture risk in patients with postmenopausal osteoporosis.Ninety-five individuals with postmenopausal osteoporosis were included in this study. Patients were divided into 2 groups with a history of vertebral fracture (n = 45) and those without (n = 50). The control group consisted of patients without fractures while the study group was subdivided into 2 subgroups: single-level (n = 29) and multiple-level vertebral fractures (n = 16). None of the study participants had a history of non-vertebral fracture. All patients with a history of vertebral fracture were in the chronic phase without any complaints of pain. Thoracolumbar radiograph, computed static posturography, FRAX (fracture risk assessment tool) scores, DXA (Dual-energy x-ray absorptiometry) measurements, serum 25(OH)D values, tandem test, timed up and go test (TUG), Berg balance scale (BBS) were performed.The probability of FRAX-major osteoporotic fracture, lumbar total T-score and TUG time were significantly higher and the BBS score was lower in the study group. The mean TUG time was 11.69 ± 3.81 s in the study group and 9.87 ± 2.57 s in the controls, while the mean BBS score was 52.73 ± 3.80 s in the study group and 55,28 ± 1,59 s in the control group (p < 0,005). The probability of FRAX-major osteoporotic fractures was significantly higher in patients with multiple level fractures compared to the patients with a single level fracture. There was also a moderately negative correlation between TUG and BBS, and between the BBS and fall index. The fall index was 43.73% ± 26.34% in the study group and 34.14 % ± 24.04% in the controls (p: 0.058).This study showed that the presence of a vertebral fracture may have a negative impact on balance and physical performance, leading an increase in the risk of falls and fractures in patients with postmenopausal osteoporosis. The risk factors should be evaluated cautiously to prevent the patients from this vicious circle.