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Pathologic vertebral compression fractures (VCF) are relatively common in patients with metastatic cancer and can significantly affect quality of life. Historically, these painful and sometimes debilitating fractures have been treated conservatively with pain medications and bracing. Minimally invasive vertebral augmentation procedures (VAP), including vertebroplasty and kyphoplasty, are now available and have been proven to alleviate pain and improve quality of life for select patients. Diagnosing symptomatic pathologic compression fractures and identifying those patients who would benefit from VAP in a timely manner are essential. This includes understanding the potential complications and absolute contraindications of VAP so as to minimize the potential risks while carefully selecting those patients who are likely to benefit based on their clinical history, physical exam findings, and diagnostic imaging. Radiofrequency ablation is a recently described procedure that can be performed as a stand-alone therapy or in conjunction with VAP for pathologic VCF to provide pain relief and potentially aid in local tumor control.