Osteoporosis is a metabolic disease that can lead to an increase in bone fragility by deteriorating cancellous bone quality. Osteoporotic spine fractures occurring on the basis of osteoporosis are the most common complication of osteoporosis due to increased bone resorption and decreased bone regeneration. Treating patients first for osteoporosis is crucial because it affects the outcome of any necessary surgery, and patients admitted for osteoporotic spine fractures have a five-fold increased risk of future spine fracture recurrence. Progressive depression fractures, kyphotic deformities, and neural compression due to narrowing of the spinal canal or intervertebral foramen may be observed. While percutaneous cement support (vertebroplasty/ kyphoplasty) to the vertebral body is usually sufficient in the absence of deformity or neural compression, in some circumstances, decompression and instrumented stabilization may be required. Patients with osteoporosis have a high risk of failure in instrumented surgery due to reasons such as morbidities, mechanical insufficiency of the bone and difficulty in fusion. Although it is aimed to increase implant stability by strengthening pedicle screws or lengthening instrumentation and to accelerate fusion with good bone grafting, it should be kept in mind that spinal instrumentation may fail due to insufficient bone mineral density, and revision surgery(s) or new fusion planning may be required in the presence of pseudoarthrosis.