Introduction: Osteoporosis is rapidly becoming a significant healthcare burden in a population aged over 69 years. Dorsolumbar osteoporotic compression fractures are common between these patients. Percutaneous vertebroplasty (PVP) is considered a minimally invasive method to relieve the pain secondary to vertebral fracture. Aim of study: This study aimed to compare the role of conservative treatment to percutaneous vertebroplasty that is used to treat stable dorsolumbar vertebral fractures in osteoporotic patients. Patients and methods: This prospective cohort study was carried out in the Department of Neurosurgery, School of Medicine, Zagazig University Hospitals at Gamal Abdelnaser Insurance Hospital in Alexandria. The study included thirty-six patients with osteoporosis. 18 people have received treatment for their spinal compression fractures by conservative management and eighteen patients have been treated by percutaneous vertebroplasty. Results: The most common level of fracture was thoraco-lumbar junction (61% in both groups). Single fractures were more common than double fractures in both groups. Patients in PVP had significantly improved clinical outcomes of VAS of the back and leg and ODI scores at 6 months follow-up compared to those at the conservative group. There was marked improvement in ODI and VAS score immediate post-operative and six-month follow-up in PVP group with a high statistically significant difference. Conclusion: Percutaneous compared to conservative treatment, vertebroplasty can offer better clinical and radiological results for individuals with osteoporotic vertebral fractures.