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Objective: To compare the clinical outcome and complications of high viscosity and low viscosity polymethyl methacrylate bone cement PVP for severe OVCFs. Methods: From December 2010 to December 2012,32 patients with severe OVCFs were randomly assigned to either group H using high viscosity cement (n = 14) or group L using low viscosity cement (n = 18). The clinical outcomes were assessed by the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Short Form-36 General Health Survey (SF-36), kyphosis Cobb's angle, vertebral height, and complications. Results: Significant improvement in the VAS, ODI, SF-36 scores, kyphosis Cobb's angle, and vertebral height were noted in both the groups, and there were no significant differences between the two groups. Cement leakage was seen less in group H. Postoperative assessment using computed tomography identified cement leakage in 5 of 17 (29.4%) vertebrae in group H and in 15 of 22 (68.2%) vertebrae in group L (P=0.025). Conclusions: The PVP using high viscosity bone cement can provide the same clinical outcome and fewer complications compared with PVP using low viscosity bone cement. [ABSTRACT FROM AUTHOR]