OBJECTIVES: The clinical burden associated with osteoporotic vertebral body compression fracture (VCF) has been well documented in the literature.  Less information is available on the economics of interventions for treatment of VCF—including vertebroplasty and kyphoplasty—which are reported to be equally efficacious options for patients suffering from this debilitating condition.   This study seeks to quantify hospital costs associated with vertebroplasty and kyphoplasty. METHODS: Analysis of hospital discharge and billing records extracted from the Premier Perspective™ database, 2007-2008.   The Premier database contains clinical and financial information from over 600 hospitals.  Independent-sample t tests were used to test for between-group differences in total and department-specific direct medical costs incurred during the index inpatient or outpatient procedure.   RESULTS: A total of 3617 patients received vertebroplasty (64% inpatient and 36% outpatient) and 8,118 received kyphoplasty (54% inpatient and 46% outpatient) for treatment of VCF.   Patients in the vertebroplasty group had a mean age of 78, and patients in the kyphoplasty group had a mean age of 76.  More patients in the vertebroplasty group (14.5%) had an APR-severity rating of “major” or “extreme” than patients in the kyphoplasty group (9.5%). Mean total inpatient costs were $9,837 for vertebroplasty compared to $13,187 for kyphoplasty (p <0.0001). Mean total outpatient costs were $3,319 for vertebroplasty compared to $8,100 for kyphoplasty (p <0.0001).  Adjustments to control for differences in age, sex, admission status, and disease severity accentuate these differences. CONCLUSIONS: Compared to kyphoplasty, vertebroplasty is a cost-minimizing option for treatment of VCF, reducing hospital costs by nearly $5000 for outpatient procedures and by more than $3000 for inpatient procedures.  These differences occurred despite older age and greater disease severity for patients in the vertebroplasty group.   Further research is necessary to evaluate the incremental cost effectiveness of treatment options for VCF.