OBJECTIVE: To compare the efficacy of posterior kyphoplasty (PKP) and vertebroplasty (PVP) in the treatment of osteoporotic vertebral fractures in the elderly. METHODS: Thirty-five elderly patients with osteoporotic vertebral fractures in our hospital from March 2011 to March 2015 were collected in 2 groups, 16 cases of PKP and 17 cases of PVP, and the VAS scores, recovery of relative vertebral body height, operation time, bone cement dosage and bone cement leakage before and after surgery were compared between the 2 groups. RESULTS: At a mean follow-up of 11 months, the VAS scores decreased in both groups before and after surgery, and the patients’ pain improved significantly without statistical differences; the operative time in the PKP group, mainly intraoperative fluoroscopy, was more than that in the PVP group, but the postoperative recovery of injured vertebral height was better than that in the PVP group; there were no statistical differences in the amount of bone cement and bone cement leakage between the two groups. Conclusion: Both PKP and PVP are minimally invasive surgical methods, which can effectively and quickly relieve patients’ pain and facilitate early activity and rehabilitation, but PKP has better postoperative recovery of vertebral height and correction of kyphosis deformity than PVP.