Ninety-eight patients with one to three painful osteoporotic vertebral compression fractures were randomized to receive either core decompression of the vertebral body (n=48) or conservative treatment (n=50). The primary outcome of interest was the visual analog scale (VAS) pain score at 3 months. Secondary outcomes included the Oswestry Disability Index (ODI), European Quality of Life-5 Dimensions (EQ-5D) score, and radiographic measures (compression rate and wedge angle). Outcomes were assessed at baseline, 1 month, and 3 months. Overall, the results revealed no significant differences between the groups in VAS pain scores at 1 month or 3 months, nor in ODI, EQ-5D, or radiographic outcomes. The findings suggest that core decompression did not provide superior outcomes compared to conservative treatment for painful osteoporotic VCFs at 3 months.