Objective To develop an intelligent follow-up system for older patients with osteoporotic vertebral compression fractures (OVCFs) and evaluate its effectiveness in postoperative rehabilitation management. Methods Using a convenience sampling method, 120 older patients with OVCFs attending the outpatient department of a tertiary Grade A hospital were recruited and assigned to a control group (n=60) and an intervention group (n=60) according to admission time. The control group received routine follow-up nursing care, whereas the intervention group received follow-up management through a newly developed intelligent follow-up system. Medication adherence, osteoporosis-related knowledge, Oswestry Disability Index (ODI) scores, and bone mineral density (BMD) values were compared between the two groups before and 6 months after the intervention. Results After the intervention, the intervention group demonstrated significantly higher scores for medication adherence and osteoporosis-related knowledge, as well as significantly higher bone mineral density values, compared with the control group. In contrast, lumbar dysfunction scores were significantly lower in the intervention group than in the control group (all P<0.05). Conclusion The application of an intelligent follow-up system can improve medication adherence and osteoporosis-related knowledge among older patients with OVCFs. Furthermore, it effectively alleviates lumbar dysfunction and improves osteoporosis-related outcomes.