Abstract. Percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) is utilized for the treatment of vertebral compression fractures (VCFswith a history of malignancy, malignancy was identified in 25 patients, while osteoporosis was identified in 16 patients. Biopsies of the other 3 patients were not suitable for pathological examination. There were only 2 patients with previously undiagnosed malignancy. One patient was diagnosed with multiple myeloma, while another patient was diagnosed with metastatic carcinoma. In the present study, the rate of unsuspected malignancy was 0.4%. No symptomatic complications occurred as a result of biopsy. The results indicate that biopsy is safely performed during PVP or PKP and it is an efficacious procedure that verifies the pathological process and assists in identifying previously unsuspected processes responsible for VCFs. We recommend obtaining the biopsy of every collapsed vertebral body during PVP or PKP procedures.