STUDY DESIGN: Prospective, double-cohort study. OBJECTIVE: To evaluate conservative and percutaneous vertebroplasty (PV) management of osteoporotic vertebral fractures. SUMMARY OF BACKGROUND DATA: PV is an elective alternative to conservative management for the treatment of a painful osteoporotic vertebral fracture. METHODS: We performed a prospective study consisting of 101 consecutive patients who underwent PV and 27 patients who refused PV treatment and were managed conservatively. We used a data evaluation and outcomes system that was developed to evaluate the outcomes of surgical intervention. RESULTS: Patients that elected for PV as a treatment of their fractures had significantly more pain and functional impairment before the procedure than the patients of the conservative group (P < 0.001). The pain, functional, and general health scores of the PV group were improved from the preoperative mean values (P < 0.001) in all postoperative periods. Compared with the conservative treatment group, there was a significant difference at month 3. However, no statistical differences on function were observed between these groups at 6 months and 1 year posttreatment. CONCLUSIONS: PV demonstrated a rapid and significant relief of pain and improved the quality of life. PV election for treatment of painful osteoporotic vertebral fracture after 6 weeks of conservative treatment was based on pain and functional impairment.