ESR Essentials: Vertebral augmentation for osteoporotic fractures-practice recommendations by the Cardiovascular and Interventional Radiological Society of Europe.

Osteoporotic vertebral compression fractures (OVCFs) pose a significant global health challenge, frequently leading to chronic pain, reduced mobility, and increased morbidity and mortality. Management options include conservative therapy, pharmacological treatment, and vertebral augmentation. In this latter field, vertebroplasty (VP) and balloon kyphoplasty (BKP) have proven to be successful in managing painful OVCFs, with faster pain relief and functional recovery, as well as reduced complications, morbidity, and mortality rates compared to non-surgical approaches. Optimal outcomes are obtained when vertebral augmentation is provided 3-6 weeks after the onset of the fracture. Among the different vertebral augmentation techniques, VP presents a cost-effective and widely accessible option, whereas BKP offers further advantages in restoring vertebral height and kyphotic deformity. Nevertheless, BKP is technically more challenging and more time- and resource-consuming compared to VP. For this reason, BKP is reserved for selected patients, such as those with a relatively long life expectancy. In addition to vertebral augmentation, long-lasting anti-osteoporotic medication is crucial for the long-term prevention of new OVCFs. This manuscript offers practical recommendations for the management of OVCFs and encourages the appropriate use of vertebral augmentation techniques. Key Points There is growing evidence that early intervention with vertebral augmentation may benefit patients with osteoporotic fractures, though consensus on timing and patient selection is still evolving. Early vertebral augmentation improves pain relief and patients' morbidity and mortality. Tailored approach: vertebroplasty for accessibility; balloon kyphoplasty for vertebral height restoration.