Objective: To analyze the influencing factors of re-collapse and explore prevention measures in elderly patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP). Methods: A retrospective selection was made of 180 patients who underwent percutaneous kyphoplasty (PKP) at our hospital from January 2023 to June 2024. These patients were divided into a collapse group (n = 60) and a non - collapse group (n = 120) based on whether vertebral collapse occurred within 1 year. Clinical relevant data of patients from two groups were collected.The influencing factors of re-collapse in elderly patients with OVCF after PKP were analyzed by univariate and multivariate analysis, and prevention measures were proposed based on the analysis results. Results: The age of patients in collapse group was older than that in non-collapse group (P<0.05). The T value of bone mineral density in collapse group was lower than that in non-collapse group, and proportion of taking anti-osteoporosis drugs was also lower than that in non-collapse group (P<0.05). The incidence of bone cement leakage and proportion of dense bone cement distribution in collapse group were higher than those in non-collapse group (P<0.05). The results of multivariate Logistic analysis showed that bone cement leakage and dense bone cement distribution were independent risk factors of re-collapse, while T value of bone mineral density was a protective factor (P<0.05). Conclusion: The bone cement leakage and dense bone cement distribution are independent risk factors of re-collapse in elderly patients with OVCF after PKP, while T value of bone mineral density is a protective factor. Clinically, the risk of postoperative re-collapse can be reduced by strengthening anti-osteoporosis treatment before and after surgery and standardizing PKP operation.