There is a vast array of literature comparing treatment modalities for vertebral augmentation, which includes balloon kyphoplasty (BKP); vertebroplasty (VP); and non-surgical management (NSM). This has produced differing and sometimes contradictory conclusions in determining the efficacy of these procedures, which prompts further investigation into the design and outcome measures of these studies. This review examines the recent literature on the management of vertebral compression fractures and offers insight on the Level I and Level II trials comparing these treatment modalities, with specific focus on design, endpoints, and outcome measurements. The review emphasizes the idea that no one study can be held as gospel, and further studies with standardized methods of inclusion and measuring outcome are necessary to determine which patients will enjoy the greatest benefit from each treatment modality.