Abstract：Objective To explore the effectiveness, safety, and prognosis of minimally invasive surgical in elderly patients with osteoporotic vertebral compression fractures. Methods A total of 100 patients with vertebral compression fractures admitted to Ansteel Group General Hospital from January 2018 to January 2023 were enrolled. Patients were assigned in a 1:1 ratio using a random number table method to either the control group （n＝50）, which received conventional conservative treatment, or the study group （n＝50）, which underwent percutaneous kyphoplasty （PKP）. Heart rate and mean arterial pressure （MAP） at different postoperative time points were compared between the two groups. Postoperative pain levels and the incidence of complications were also recorded. Results The heart rates of the study group on postoperative days 3 and 4, as well as the mean arterial pressures on postoperative days 2, 3, and 4, were lower than those of the control group. The pain scores of the study group at various time points were significantly lower compared to the control group, and the differences between the groups were statistically significant （t＝4.603, 5.310, 3.300, 2.876, 3.642, 4.180, 5.570, 3.620, all P＜0.05）. The incidence of postoperative complications in the study group was lower than that in the control group, and the difference between the groups was statistically significant （χ2＝4.000,P＜0.05）. Conclusion In elderly patients with osteoporotic vertebral compression fractures, PKP can significantly improve clinical outcomes, reduce pain scores, and lower the incidence of complications. It demonstrates high clinical safety and is worthy of clinical promotion and application.