Osteoporotic vertebral compression fractures (OVCF) affect about 7,00,000 to 10,00,000 individuals in the United States costing $746 billion. Of these, around 1,50,000 are refractory to the outpatient treatment leading to hospitalization and protracted bedrest. Similar figures are not available for Indian population. They are common in females and their incidence increases by 25% after the age of 50 years and an abrupt increase to about 40 to 50% in the eighties.Majority are managed conservatively with analgesics, bedrest and spinal support with braces. Spontaneous resolution of pain occurs within 4 to 6 weeks in many patients. The complication rate is directly proportional to the volume of cement injected. These complications are catastrophic and need to be avoided. In case of doubt, it is preferable to underfill the vertebral body rather than overfill it. New osteoconductive synthetic composites are the emerging alternatives to cement. Advances in minimally invasive surgical techniques, imaging and synthetic engineering are rapidly changing the treatment protocols available for osteoporotic compression fracture.