Objective To investigate the clinical effect of the treatment of osteoporotic vertebral compression fractures in the elderly populationthrough different surgical approaches.Methods 98 cases with a single-level osteoporotic vertebral compression fracture in the elderly population were randomly divided into two groups from February 201 1 to June 2013.48 patients were performed by percutaneous vertebroplasty (PVP)through unipedicular approach and 50 patients through bipedicular approachs.The clinical data of patients were prospectively analyzed and the clinical efficacy were compared between two groups using VAS (visual analogue scale method)and ODI (Oswestry disability index)in preoperative,postoperative 1 day and 1 year postoperatively .The data of age, gender,injury to the patients with operation time,postoperative follow-up time,operation time,bone cement injection,bone cement leakage and other complications were observed.Cobb angle,vertebral compression ration were observed by imaging data.Results All the cases were followed-up.There was no statistical difference in preoperative clinical data between the two groups (P >0.05).In unilateral group (48 cases),the data of operation time,bone cement injection,bone cement leakage,Cobb angle improve,vertebral compression ration improve were (34.87±5.91)min,(6.20±0.66)mL,1 6 cases(33%),(10.1 9±2.12)%,(13.23°±1.58°)and adjacent vertebral fractures was 10 cases (20.9%).VAS score was respectively improved (4.05 ± 0.12 ),(5.42 ± 0.12 ) in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.40 ±0.1 1 )in postoperative 1 year than 1 day.ODI score was respectively improved (35.46 ± 1.89)%,(47.88 ±2.21 )% in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.42±0.24)% in postoperative 1 year than 1 day.In bilateral group (50 cases).The data of operation time,bone cement injection,bone cement leakage,Cobb angle improve, vertebral compression ration improve were (41.66±6.90)min,(4.88±0.52)mL,9 cases(18.0%),(10.48±1.43)%,(13.04°±2.03°)and adjacent vertebral fractures was 6 cases(12.0%).VAS score was respectively improved (4.06±0.1 1),(5.30±0.10)in postoperative 1 day and 1 year than preoperative.VAS score was improved (1.34± 0.08)in postoperative 1 year than 1 day.ODI score was respectively improved (36.08±2.13)%,(47.54±1.97)%in postoperative 1 day and 1 year than preoperative.ODI score was improved (1 1.26 ± 0.54)% in postoperative 1 year than 1 day.There was no obvious clinical problems after occurred leakage in two groups.there was statistical difference in cement injection,bone cement leakage and postoperative adjacent vertebral fractures after operation between the two groups.there was no statistical difference in Cobb angle improve,vertebral compression ration improve,VAS score and ODI score between the two groups.Conclusion Both approaches are effective in the treatment of osteoporotic vertebral compression fractures in the elderly population ,but there is advantage of decrease the incidence of bone cement leakage and postoperative adjacent vertebral fractures through bilateral approach.