Objective To investigate the biomechanical properties and clinical effects of the unilateral/bilateral percutaneous vertebroplasty (PVP) on the treatment of osteoporotic vertebral compression fractures in elderly patients. Methods The finite element models of the unilateral/bilateral percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures were established to evaluate changes in strain and stress of the fractured vertebra after surgery. Eighty patients with osteoporotic vertebral compression fractures underwent unilateral or bilateral PVP were collected for retrospective analysis. The operation time,intraoperative fluoroscopy times,injected bone cement volume, bone cement leakage rate and visual analogue scales (VAS) score between the two groups were analyzed. Results The maximum strain and stress in unilateral PVP group were 1.18 times and 1.15 times of those in bilateral PVP group,respectively.The operation time and intraoperative fluoroscopy times in unilateral PVP group were obviously smaller than those in bilateral PVP group (P<0.001). There was no statistical significance in the injected bone cement volume, bone cement leakage rate, and VAS score between the two groups (P>0.05).Conclusions The biomechanical effect of unilateral PVP was similar to that of bilateral PVP. The puncture needle localization of unilateral PVP for treating elderly patients with osteoporotic vertebral compression fractures had the advantage of less operation time and limited X-ray exposure.