Barker KL, Newman M, Stallard N, et al. - In this prospective, multicentre, adaptive, three-arm randomized controlled trial of 615 adults with back pain, osteoporosis, and at least one osteoporotic vertebral fracture (OVF), experts assessed the clinical and cost-efficiency of various physiotherapy approaches for individuals with OVF. At 12 months, no statistically important variations between groups were noted. Compared with a single session of physiotherapy education (SSPT), the exercise gave more quality-adjusted life-years however, it was more expensive. At 4 months, in endurance and balance in manual therapy, and in endurance for those ≤ 70 years, in balance, mobility, and walking in exercise, notable variations above SSPT transpired. In conclusion, adherence was uncertain. Advantages at 4 months did not continue and at 12 months, no notable variations between treatments could be seen. Moreover, there is insufficient evidence a short physiotherapy intervention of either manual therapy or home exercise provides long-term advantages, however, arguably short-term advantages are significant.