Objective To evaluate the clinical efficacy of percutaneous bipedicular kyphoplasty with double or single balloon in treatment of elderly patients with osteoporotic vertebral compression fractures(OVCFs). Methods From April 2008 to Feb 2010, 26 patients with OVCFs involving 35 vertebrae were treated by percutaneous kyphoplasty(PKP), and randomized to single or double balloons group. The average age of the single balloon group ( 15 patients with 21 involved vertebrae) was 72 years and that of the double group (11 patients with 14 vertebrae) was 70.8 years. Each procedure included insertion of inflatable balloon(single or double), fracture reduction and cement filling under monitoring. Preoperative and postoperative pain levels, radiographs and complications were recorded and analyzed. Results The mean operation time were 37.5 (33～85)min and 33.9 (30～75)min for single and double balloon groups respectively. The mean follow-up duration was 14.8 (12～18)months. The mean VAS pain score of single balloon group decreased significantly from 7.6±2.2 preoperatively to 2.5±1.8 postoperatively (P＜0.05) and 3.1±2.0 at final follow-up, the mean VAS pain score of double balloon group decreased significantly from 7.9±2.3 preoperatively to 2.4±2.0 postoperatively (P＜0.05) and 2.9±2.1 at final follow-up, while no significant difference in changes of VAS pain was found between two groups. Significant increase of the mean height of anterior and medial vertebral body were observed after the operation and maintained at final follow-up for both groups (P＜0.05). The mean correction of local kyphosis was (7.0°±4.5°) for single balloon group and (7.7°±3.9°) for double balloon group, and no significant difference was found between two groups. Conclusions PKP is effective and relatively safe for OVCFs with either single or double balloons.