Twenty randomized controlled trials containing 2566 patients with painful osteoporotic vertebrate compression fractures (OVCFs) who have been treated with a vertebral augmentation procedure (percutaneous vertebroplasty [PVP]; balloon kyphoplasty [BKP]) or non-surgical management (NSM) were included in this meta-analysis. The primary outcomes of interest were pain relief on a Visual Analog Scale (VAS) and functional improvement measured with the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included quality of life, disability, medical outcomes, kyphotic wedge angle, vertebral height, and new vertebral fractures. The results revealed that there were significant differences between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in the visual analogue scores (VAS) at each follow-up time points with PVP having a beneficial effect on the treatment of OVCFs. The subgroup analyses presented significant differences between PVP and CT when considering fracture type, duration of back pain, and location. Significant differences were recorded between CT and BKP when considering RMDQ at 1 and 6 months but no definitive conclusions can be made on whether PVP or BKP is more effective in functional recovery.