Objectives: Document initial outcomes of balloon kyphoplasty. Design: Retrospective analysis of the first 52 patients with 82 painful vertebral body compression fractures secondary to osteoporosis treated at our institution. Setting: Operation on subacute painful fractures with office follow-up. Patients/Participants: First 82 fractures in 52 patients treated. All patients had failed nonoperative treatment and had magnetic resonance imaging scans documenting edematous changes of the vertebral body. Forty-nine out of 52 patients presented for follow-up at ail average of 37 weeks. Intervention: Minimally invasive balloon reduction via bilateral transpedicular or extrapedicular approaches followed by polymethyl methacrylate fixation. Main Outcome Measures: Vertebral body height, Cobb angle, visual analogue pain scale, Roland-Morris Disability Survey, and complication rate. Results: Mean length Of follow-up was 9 months (37 weeks, range 4-99 weeks); improved height 4.6 and 3.9 mm in the anterior and medial columns, respectively (P > 0.05); Cobb angle increased 14% (P < 0.05), visual analogue pain scale score improved 7 points (P < 0.05); Roland-Morris Disability Survey improved 11 points (P < 0.05); no adverse medical or procedural complications; 9.8% cement leakage rate. Conclusion: Balloon kyphoplasty safely improves vertebral body height and patient quality of life.