112 osteoporotic patients were randomized to determine the effect of curette use in balloon kyphoplasty. Subjects were allocated to receive a curette-first procedure, whereby the curette was used prior to the inflation of the bone tamps, or an inflatable-bone-tamps (IBT)-first procedure, performed with IBT inflation, then curette use, and followed by a second IBT inflation. Imaging assessments were performed intra- and post-operatively. Clinical outcome of pain was also assessed postoperatively, and adverse events were recorded up to 30 days after surgery. The results indicated that the timing of curette use was non-determinate of outcome, as significant improvements in vertebral body height, deformity angle, and pain were observed in both groups.