Osteoporotic spinal fractures are frequently observed nowadays due to increased life expectancy. Weakening of the spine and associated vertebral fractures must be thoroughly evaluated to preserve patients` quality of life and functionality. Achieving stabilization and preventing new bone deformities in osteoporotic spines are challenging due to the fragile bone structure. Therefore, many studies from past to present have addressed osteoporotic spinal fractures. However, consensus on patient selection, timing of surgery, and the preferred surgical method has not yet been reached. This section evaluates the approaches to osteoporotic spinal fractures.