Bone fractures, especially vertebral compression fractures, are well-known complications of convulsive seizures. Acute vertebral fractures of unclear cause, often labeled idiopathic, may be due to unwitnessed epileptic seizures. We reviewed the records of 2 patients with new onset of seizures seen at the Adult Epilepsy Clinic at the Henry Ford Hospital, Detroit, Mich, who had a history of vertebral compression fractures preceding the diagnosis of epilepsy. The patients, who had no risk factors for pathologic fractures, awoke with severe midback pain. X-ray films revealed thoracic vertebral fractures in both patients. The first recognized seizure occurred 1 week later in 1 patient and 6 months later in the other. Nocturnal vertebral compression fractures may be the presenting feature of unwitnessed convulsive seizures, and evaluation for epilepsy should be considered in cases of idiopathic vertebral compression fractures.