In summary, this study offers recommendations for treating patients with osteoporotic vertebral fractures. It also defines acute fracture based more on clinical behavior and imaging, with MRI as a gold standard for acute fractures. Medical treatment is considered appropriate for all patients. Vertebral augmentation is rarely appropriate in the presence of instability or stenosis with neurologic changes, but is an option in patients with acute fractures, higher pain scores, functional impairment, and simple fracture patterns. Surgical reconstruction, on the other hand, is particularly appropriate in presence of instability or stenosis with neurologic changes.