Background <p>Osteoporotic fractures and their complications are increasingly harmful to the elderly. The purpose of this study was to evaluate the clinical effect of postoperative cement distribution for Osteoporotic vertebral compression fracture in patients undergoing unilateral percutaneous vertebroplasty.</p> Purpose <p>To explore the effect of cement distribution on the efficacy of unilateral percutaneous vertebroplasty to provide effective preventive and therapeutic measures to prevent postoperative vertebral fracture and improve the surgical efficacy.</p> Methods <p>193 patients who underwent unilateral percutaneous vertebroplasty in our hospital from January 2019 to June 2022 were selected and divided into group I (cement not touching the upper end and distal end plates n = 59), Group II (cement touching only the upper end plate n = 42), group III (cement only touching the lower end plate n = 38) and Group IV (cement touching both the upper and distal end plates n = 54). The operation-related indicators of the four groups of patients, including operation time, total hospitalization cost, postoperative hospital stay time, cement injection, VAS and ODI score of low back pain, postoperative recovery rate of postoperative vertebral height, incidence of injured vertebral and adjacent vertebral refracture, and the follow-up results of all patients were recorded.</p> Results <p>Group IV (cement simultaneously touching both the upper and distal end plates) was significantly lower than Group I (cement does not touch the upper and distal end plates), Group II (cement only touches the upper end plate), Group III (cement only touching the lower end plate) (<i>P</i> = 0.047, 0.025, 0.027), Group I (cement does not touch the upper and distal end plates), Group II (the cement only touches the upper end plate), Group III (cement only touches the lower end plate) have a higher incidence of postoperative vertebral injuries, adjacent vertebral refractures and overall fractures than Group IV (cement touching both the upper and distal end plates), Statistically significant (<i>P</i> = 0.040, 0.028, 0.006), Bone cement dose in groups I, II, III and IV, The difference was significant (<i>P</i> = 0.018), However, the remaining indexes, including cement score, 1&#xa0;week and postoperative ODI scores, postoperative vertebral height recovery rate, local vertebral body angle, operation time, total hospital cost and postoperative hospital stay (<i>P</i> &gt; 0.05).</p> Conclusion <p>Compared with group I, II and III, patients in group IV (cement contact with the upper and distal plates) have a better long-term prognosis, and group IV (cement contact with the upper and distal plates) can significantly reduce the incidence of refracture of injured and adjacent vertebrae. Surgeons should fully grasp the diffusion of the cement, and develop targeted prevention and treatment strategies to help reduce the risk of future fractures.</p>