Objective: To investigate the effects of different Percutaneous vertebroplasty (PVP) procedures on the treatment of Osteoporotic vertebral compression fracture (OVCF) in elderly patients. Methods: 96 elderly patients with OVCF admitted to our hospital from March 2022 to February 2024 were selected as the study objects. 96 elderly patients with OVCF were divided into unilateral group and bilateral group with 48 cases in each group by random number table method. Both groups were treated with PVP. On this basis, the unilateral group was treated with unilateral puncture PVP, and the bilateral group was treated with bilateral puncture PVP. The surgery-related indexes, pain degree [Visual simulation score (VAS)], lumbar function [Oswestry dysfunction index (ODI)] and complication rate of the two groups were analyzed and compared. Results: The number of X-ray fluoroscopy and the amount of bone cement in bilateral group were significantly higher than those in unilateral group (P < 0.05), and there were no significant differences in operation time and leakage number between the two groups (P > 0.05). After surgery, the VAS scores of both groups were significantly lower than those before surgery (P < 0.05), but there was no significant difference between the two groups (P > 0.05). After operation, the ODI index in both groups was significantly lower than that before operation, and the ODI index in bilateral group was significantly lower than that in unilateral group (P < 0.05). The incidence of bone cement leakage in bilateral group was significantly lower than that in unilateral group (P < 0.05), and there were no significant differences in the incidence of delayed healing, infection, fever and residual low back pain between the two groups (P > 0.05). Conclusion: Compared with unilateral puncture, bilateral puncture can promote the recovery of lumbar function and reduce the occurrence of bone cement leakage in the treatment of elderly OVCF, but bilateral puncture can increase the number of X-ray fluoroscopy and the amount of bone cement.