Clinical value of expansive pedicle screw in lumbar short-segment fixation and fusion for patients with osteoporosis was investigated. A total of 80 patients with lumbar compression fracture but without obvious nerve compression were selected and divided into the observation group (n=40) and the control group (n=40) using a random number table. The observation group used the expansive pedicle screw, and the control group received conventional pedicle screw fixation and bone graft fusion. In the observation group, the operation and hospitalization time after operation were shorter and the intraoperative bleeding amount was less than that in control group (p<0.05). At 1 week, 1, 3 and 6 months after operation, the observation group had better straight leg raising test (SLRT) scores, higher lower limb sensory scores but lower visual analogue scale (VAS) scores than control group (p<0.05). Besides, the proportions of postoperative infection, dural mater tear, nerve root injury and spinal cord injury during operation in the observation group were lower than those in the control group (p<0.05), and the bone graft fusion rates at 3 and 6 months after operation were obviously superior to those in control group (p<0.05). Moreover, after operation, the spinal stenosis rate in the observation group was lower than that in control group (p<0.05), the vertebral height ratio was larger than that in control group (p<0.05), and the Cobb's angle was smaller than that in the control group (p<0.05). In addition, there was a negative correlation between bone mineral density (BMD) and hospitalization time after operation in the observation group (p<0.05). In conclusion, the internal fixation with expansive pedicle screw for osteoporosis patients with lumbar compression fracture is characterized by short operation time, less intraoperative bleeding, few complications, quick recovery of postoperative neurological function and satisfactory surgical effect. However, reasonable intervention in osteoporosis is also necessary.