Although vertebroplasty (VP) using polymethylmethacrylate (PMMA) is thought to be an effective procedure for osteoporotic vertebral compression fractures, several complications have been reported. In this paper, we present three patients who developed local kyphotic deformity as a result of late collapse of the cemented vertebrae. In all patients we safely removed the PMMA block through an anterior approach and anterior reconstruction was performed successfully. In only one patient who had a three column unstable injury with fractured posterior elements was additional posterior spinal fixation needed. In conclusion, VP is thought to be an effective and minimal invasive technique to treat osteoporotic compression fractures in older patients. Once collapse or nonunion of the treated vertebral body occurs, however, removal of the cement and anterior reconstruction may be required to realign of the affected segments and reconstruct the spine.