Objective To compare the effects of percutaneous vertebroplasty （PVP） and percutaneous kyphoplasty （PKP） on osteoporosis combined with thoracolumbar fracture, and to analyze the incidence rates and factors affecting postoperative low back pain. Methods A total of 133 patients with osteoporosis combined with thoracolumbar fracture from January 2018 to January 2023 were selected as study subjects. In accordance with the surgical methods, they were divided into PKP group （n=70） and PVP group （n=63）. Postoperative rehabilitation indicators were compared between the two groups, including first off-bed time, hospitalization time, visual analogue scale （VAS） score at 1 d postoperatively, Cobb's angle at 3 months after operation, vertebral height at 3 months after operation and the incidence rate of low back pain at 3 months postoperatively. The spinal function index （SFI） and the Japanese Orthopaedic Association （JOA） were used to assess the lumbar spine function of the two groups of patients before surgery and at 3 months after operation. Among the 133 patients, 40 cases （30.08%） had pain after surgery, and the factors influencing the postoperative low back pain were analyzed. Results The differences in first off-bed time, hospitalization time, VAS score at 1 d postoperatively, Cobb's angle at 3 months after operation, vertebral height at 3 months after operation, and incidence rate of low back pain at 3 months postoperatively between patients in the PVP group and the PKP group were not statistically significant （P>0.05）.The differences in preoperative SFI and JOA scores between the two groups were not statistically significant （P>0.05）; the SFI and JOA scores of the two groups at 3 months postoperatively were significantly higher compared with preoperative scores （P<0.05）, but the differences between the groups were not statistically significant （P>0.05）. There were no significant differences in gender, age, body mass index （BMI）, surgical method, affected body part, anesthesia mode, combined hypertension, hyperlipidemia, other underlying diseases, and combined soft tissue injury between the non-low back pain patients and the low back pain patients （P>0.05）, but there were significant differences in preoperative bone mineral density （BMD）, Cobb's angle, combined diabetes mellitus, VAS scores, and fracture history between the non-low back pain patients and the low back pain patients （P<0.05）. The results of logistic regression showed that preoperative BMD, preoperative Cobb's angle, combined diabetes mellitus, and fracture history were independent risk factors for osteoporosis combined thoracolumbar fracture. Conclusion Both PVP and PKP treatments for osteoporosis combined thoracolumbar fractures can improve patients' lumbar spine function. Preoperative BMD, preoperative Cobb's angle, combined diabetes mellitus, and fracture history are the independent risk factors for postoperative low back pain in patients with osteoporotic thoracolumbar fracture. Therefore, timely measures should be taken to prevent postoperative low back pain in such patients.