Objective To compare the clinical effect of autogenous bone and polymethylmethacrylate (PMMA) augmentation of screw fixation in degenerative scoliosis with osteoporosis. Methods A retrospective analysis was conducted on 31 consecutive patients with degenerative scoliosis combined with osteoporosis who accepted pedicle screw fixation from December 2000 to December 2006. Fourteen of them underwent fixation with pedicle screw by augmentation with PMMA and the other 17 patients with autogenous bone. Peri-operative data were recorded. Preoperative, postoperative and final follow up corrective effects were compared. Results No significant difference was found in clinical data except for administration time of oral pain relief medicines and surgery cost between the two surgical strategies. Cement leakage was observed in 2 patients in PMMA augmentation group, but there was no evidence of nerve damage. Conclusion There is no difference in surgical effect between two surgery strategies on degenerative scoliosis combined with osteoporosis. Less oral pain medicines are taken in the polymethylmethacrylate-augmented pedicle screw fixation and fusion, but with much more cost and danger of cement leakage.