Pain adequately controlled with oral analgesics

No neurological deficits

Ability to ambulate independently

Low burden of comorbidites

Osteopenia (T-score > −2.5)

Absence of frailty indicators

Vertebral body height loss <25%

Stable fracture morphology (absence of posterior wall involvement or retropulsion)

Persistent or progressive pain beyond 4–6 weeks despite conservative measures

Reduced ambulation ability and performance of daily tasks

Early signs of frailty (sarcopenia, recent falls)

Mild-to-moderate burden of comorbidities Osteoporosis (T-score −2.5 to −3.5)

Absence of neurologic deficits

Vertebral body height loss between 25% and 50%

Emerging or progressive segmental kyphosis

Initial course of non-operative management. Consideration of vertebral augmentation in case of persistent pain or radiographic progression of deformity

Escalating pain, refractory to medical therapy

Neurological involvement

Significant frailty or dependency in daily activities

High comorbidity burden

Severe osteoporosis density (T-score ≤ −3.5)

Documented failure of non-operative management

Vertebral body collapse greater than 50%

Radiographic evidence of posterior wall disruption or canal compromise

Operative management with vertebral augmentation or decompression and instrumentation, according to the neurologic status