【Objective】 To evaluate the safety and efficacy of balloon-expandable vertebral body stenting （VBS） in treating elderly patients with osteoporotic vertebral compression fractures. 【Methods】 Thirty-eight elderly patients with osteoporotic vertebral compression fractures were randomly divided into two groups according to the parity of their hospital admission numbers to receive VBS and traditional percutaneous kyphoplasty （PKP）， respectively. The two groups were compared regarding changes in the intensity of pain， functional score， imaging parameters related to vertebral compression， and sagittal Cobb angle as well as the incidence of bone cement leakage after treatment， to evaluate the safety and efficacy of VBS. 【Results】 All the patients underwent the operations smoothly， which were performed with the bilateral percutaneous puncture technique under local anesthesia by the same surgeon， and were followed up for more than half a year. Both VBS group and PKP group showed significant improvement in the visual analogue scale score， the Oswestry disability index， the height of the fractured vertebral body， and the Cobb angle at 3 days， 1 month， 3 months and 6 months after treatment （all P<0.05）. There were significant differences in those indicators between the two groups （all P<0.05）. 【Conclusion】 VBS is an effective treatment approach for elderly patients with osteoporotic vertebral compression fractures. It can effectively recover fractured vertebral body height， relieve patients’ pain， and have fewer complications such as bone cement leakage.