Osteoporosis is a metabolic disorder of the bone with decreased bone mass that leads to fragility fractures. The true incidence of osteoporosis is difficult, if not impossible, to measure. It is estimated that 30% of Caucasian women in the United States have osteoporosis. Osteoporosis is the most prevalent metabolic bone disorder in the United States. TThe National Osteoporosis Foundation has estimated that 700,000 vertebral compression fractures (VCFs) occur each year; 260,000 are persistently painful after nonoperative care (about one third). Nonoperative modalities consist of pain medication, bracing, anti-osteoporotic pharmaceuticals, and rehabilitative therapy. In cases of osteoporotic compression fractures resistant to nonoperative care, percutaneous vertebral augmentation, in the form of kyphoplasty or vertebroplasty, can be performed. This article reviews two surgical techniques in detail: kyphoplasty and vertebroplasty. Video is available.