Prior to fracture, the osteoporotic spine can be analyzed in several ways. After fracture occurs, however, a simple plain roentgenogram usually suffices to make the diagnosis of compression fracture. If severe deformity threatens, or if there is a neurologic lesion, the surgeon now has options not previously available. Open reduction, decompression, and internal fixation with polymethylmethacrylate can be carried out safely by surgeons with expertise in spinal instrumentation. Generally, symptomatic treatment is all that is required, and if this includes an orthosis, it is an individual decision which can probably be made without fear of harming the patient further. With treatment of the acute fracture undertaken, one proceeds to employ whatever pharmacologic treatment is appropriate. Last, the patient should be allowed only the briefest period of rest.