Osteoporotic vertebral compression fractures are a major burden worldwide. Percutaneous vertebroplasty is a recognised treatment option for these fractures but there is conflicting evidence regarding the optimum amount of cement to use and there is little evidence regarding the best surgical approach to treating these fractures. Newer techniques are available which expand on the basic premise of percutaneous vertebroplasty. This project aimed to provide the basic science to answer the questions of cement fill, approach and the use of modern adjuncts to traditional percutaneous vertebroplasty. The first phase looked at approaches and cement fill and found that a 30% fill via a unipedicular approach , gave the best biomechanical outcome combined with the lowest theoretical risk and that the interaction between the cement and the vertebral endplate was important for syength restoration. Phase 2 expanded on the work carried out earlier in this study and looked at the response to dynamic loading of augmented and unaugmented vertebra. It reinforced the findings of phase 1 that 30% was the key figure and the endplate-bolus interaction was key. Finally phase 3 took the work carried out in the study so far and compared cavity creation vertebroplasty using a contour osteotome with traditional balloon kyphoplasty in, a static loading environment. It demonstrated equivocal strength restoration between the two but with lower incidence of implant induced fracture in the contour group. The culmination of this project provides guidelines for the effective use of cement augmentation by percutaneous vertebroplasty as a method for restoring strength post vertebral fracture in osteoporotic patients.