Abstract: Objective：To study the relationship between cigarette smoking, smoking cessation and vertebral fractures in middle and elderly people. Methods：A convenience sample of 3 403 subjects (range 42- 72 years old) from the study of lung cancer screening in Beijing community were selected for the surveys on situation of cigarette smoking and smoking cessation. The Genant semiquantitative diagnostic approach was used to evaluate vertebral fractures from T4 to L4 on lateral scout computed tomography (CT) images of low- dose chest CT scan. The distribution of vertebral fractures was statistically analyzed. The differences of positive rate of vertebral fractures in different genders and ages were analyzed. The differences of positive rates of vertebral fractures between different smoking index and quitting time were analyzed. Results：There were 703 subjects with vertebral fractures (20.7% of all subjects), and 1 077 fractured vertebrae in total. Fractures were most common at T12, T11, and L1 levels. The percent of grade 1 fractures was 92.3%. The positive rates of vertebral fractures in male were higher than those in female in all groups aged less than 65 years old (P<0.001). There was no statistically significant difference in the positive rate of fractures between the male and female groups aged 65 years old and above. The positive rates of vertebral fractures in smokers, ex- smokers were 23.3% and 21.8% respectively, higher than those in non- smokers (14.2%), and the differences were statistically significant (P<0.01). The positive rates of vertebral fractures in mild, moderate, and severe smokers were 19.2%, 27.7%, and 23.2% respectively. The difference between moderate smokers and non- smokers was statistically significant, as well as the difference between severe smokers and non- smokers (P<0.001). The positive rates of vertebral fractures in ex- smokers quitting for less than 5 years, 5 to 10 years, and more than 10 years were 23.1%, 19.9%, and 23.1% respectively. Among them, the difference between ex- smokers quitting for less than 5 years and non- smokers was statistically significant (P=0.003). Conclusions：The incidences of vertebral fractures would rise when the smoking index is more than 200 cigarettes a year or quitting smoking within 5 years, which should be paid attention to.