Although osteoporotic late collapse of a vertebral body is a common infirmity of old age, it has not been well studied, and no consensus regarding treatment of this condition has been reached. Forty-five patients with osteoporotic late collapse of a vertebral body were classified into six types based on the appearance on the lateral projection of a radiograph and the presence or absence of neurologic symptoms and were evaluated on imaging and clinical outcome. We concluded that the treatment of osteoporotic late collapse of a vertebral body can be individualized based on several factors such as the presentation of the fracture and neurologic condition. Conservative treatment can be selected in patients without neurologic involvement who have the concave type with anterior spur or sclerotic change or flat type with uniform compression of collapse. If the patients in those types of collapse show neurologic involvement, decompression and reconstruction through a posterior approach, including an eggshell procedure and the short segment pedicle screw system, are more suitable. Anterior decompression with anterior strut bone graft and anterior spinal instrumentation should be done for wedged type of collapse regardless of neurologic status.