Thorough evaluation of the patient with osteoporotic vertebral compression fractures is mandatory. Dietary advice, patient counseling and medical management of osteoporosis is important in preventing the long-term consequences of osteoporosis. Various techniques are available for the management of osteoporotic spine fractures. Minimally invasive percutaneous techniques help in decreasing the morbidity and mortality associated with spine surgery in this group of patients. With availability of newer instrumentation and surgical techniques, modern anesthesia, better understanding of biomechanical properties of osteoporotic spine and improved postoperative care many patients are offered surgeries to help alleviate pain, improve quality of life and lead healthy lives. The principles of instrumentation in osteoporotic spine should include the usage of multiple fixation points, accepting lesser degree of deformity correction and avoid stopping the instrumentation at junctional levels and within kyphotic segments.