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The incidence of vertebral fractures in patients with osteoporosis is frequent. In elderly patients, the presence of vertebral fracture without history of trauma may be present. In addition, previous diagnosis of tumor pathology raises the suspicion of metastatic disease. The presence of known or unknown primary tumor raises the need for a correct diagnosis to tailor the best treatment. Mechanical pain and neurological compression have been described in both cases. Imaging tests, x-rays, CT and MRI may help the diagnosis. The existence of prior known tumor may not require the need of previous biopsy. Treatment can range from conservative treatment with bracing and analgesia, reinforcement techniques or decompression and stabilization in deformity or neurological deficit.