Objective To explore the influencing factors of low back pain relief efficacy in elderly patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) and construct a nomogram model for the efficacy and analyze its predictive effect. Methods A total of 218 elderly OVCF patients undergoing PKP treatment in our hospital from January 2020 to December 2022 were enrolled in this study. After admission, they all underwent PKP treatment after completion of examinations. Japanese Orthopaedic Association (JOA) low back pain scale was used to evaluate the efficacy after 6 months of follow-up. According to the efficacy, they were divided into effective group (n=187) and ineffective group (n=31). The efficacy of PKP for elderly OVCF patients was analyzed and then a nomogram model was constructed to predict the PKP efficacy. SPSS statistics 23.0 was used for data analysis. Depending on data type, t test or Chi-square test was applied for comparison between groups. Multivariate logistic regression analysis was performed to confirm the influencing factors for PKP treatment efficacy in elderly OVCF patients. Rstudio program package in R software was employed to construct a nomogram prediction model, and the consistency between the predicted results and the actual observation results was verified by Boot strap method. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of the nomogram in the prediction of PKP efficacy. Results At 6 months after surgery, JOA score indicated that the surgery was effective in 187 cases (85.78%). Multivariate logistic regression analysis suggested that age (OR=1.887, 95%CI 1.273-2.798), number of fractured vertebral bodies (OR=2.980,95%CI 1.291-6.882), time from fracture to surgery (OR=1.281, 95%CI 1.128-1.456), preoperative Cobb angle (OR=0.687, 95%CI 0.523-0.902) and standardized anti-osteoporosis treatment (OR=2.596,95%CI 1.228-5.489) were all influencing factors of PKP efficacy in elderly patients with OVCF (P<0.05). Hosmer-Lemeshow fit test revealed that the nomogram model in predicting the efficacy of PKP had a χ²=1.685 and a P=0.247, suggesting that the model had good accuracy. ROC curve analysis showed that the ROC area under the curve of the nomogram model in predicting ineffective PKP treatment in elderly OVCF patients was 0.816 (95%CI 0.617-0.894; P<0.001). Conclusion The influencing factors for PKP efficacy in elderly OVCF patients are age, number of fractured vertebral bodies, preoperative Cobb angle, time from fracture to surgery and standardized anti-osteoporosis treatment. Our nomogram model based on these factors has good value in prediction of treatment efficacy.