Background: Low bone mass and microarchitectural disturbance are hallmarks of the common illness osteoporosis. Percutaneous vertebroplasty (PVP) is a substitute nowadays. Symptomatic spinal compression fractures have been treated using this minimally invasive technique all around the world. To improve functional disability and the quality of life for patients, the primary goal of this systemic review and meta-analysis was to evaluate the efficacy of vertebroplasty alone (VP) and vertebroplasty with pedicle screw fixation (PSF) in treating fragility fractures. The results of both modalities were compared in a systematic review. Methods: In this Meta-analysis and systematic study, we employed a comprehensive search strategy. Our search encompassed the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails using the following keywords related to Osteoporosis, osteoporotic fractures, vertebral compression fractures vertebroplasty, kyphoplasty, pedicular fixation, screws augmentation. Results: Our analysis for refracture including 3 studies (in case of VP) revealed a pooled proportion 0.21 (95% CI (0.10,0.4)). A significant high heterogeneity was found (I2=70%, p.value=0.04) & leave one study had no effect on lowering it. It's noticed that VP had higher incidence of refracture (0.21) than PSF combined with VP (0.13). Conclusion: This systemic review and meta-analysis comparing both PV and PV with PSF for treatment of osteoporotic fractures demonstrated that both techniques are safe and effective in short and long term pain control, vertebral height restoration. However, VP combined with pedicle screw was superior to PVP alone for lower cement leakage rate and incidence of refracture.