To the Editor: I read with great interest the brief report by Dr. Nizar Al-Nakshabandi entitled “Percutaneous vertebroplasty in patients with osteoporotic vertebral body fractures.”1 Certain issues need to stand corrected. The author’s assertion that “there are no well established pain management protocols” is untrue. If this is the indication for vertebroplasty then it is incorrect to do the procedure. The author has failed to mention anywhere in the article the indications for vertebroplasty in general and the indications in their patients. It is important to make clear that the prime indication of vertebroplasty is failure of conservative treatment of osteoporosis2 or vertebral fractures refractory to medical therapy.3Osteoporosis particularly in postmenopausal women is a growing problem in Saudi Arabia and it appears it will grow further with the aging of population.4,5 The author discussed the study of El-Desouki et al6 which appeared to be out of context as it does not indicate any prevalence of osteoporosis related vertebral fractures. The reported prevalence of osteoporosis-related vertebral fractures in the Saudi society was 18.2% and none of these patients were treated by vertebroplasty.7It is unfortunate that the author failed to mention in the conclusion that vertebroplasty is not a procedure to be taken lightly and has its own complications and needs to be done at regional centers where such procedures are done on a regular basis.