Vertebral bone pain can result from traumatic, compression or pathological fractures. Pathological fractures are more commonly related to osteoporosis (OP), which is more prevalent in older, postmenopausal Caucasian females with history of smoking, prior fractures, hyperthyroidism, heparin use, low bone mineral density (BMD) and chronic steroid therapy. Conservative management of vertebral bone pain includes age appropriate calcium and vitamin D intake. Rehabilitation should include education, lumbar extensor strengthening, weight-bearing exercises and modalities such as heat for pain relief. Medications for pain and prevention include use of analgesics, bisphosphonates, selective estrogen receptor modulators, and calcitonin. Newer treatments with sclerostin inhibitors that enhance osteoblast function and improve bone mass are being studied.