For a retrospective cohort study, the researchers wanted to compare various features of fusion surgery in osteoporosis patients, including graft subtype and surgical method. Osteoporosis and chronic lower back pain are frequent among the elderly, and they raise the risk of compression fractures in the spine. The researchers found 11,086 osteoporotic patients with lumbar fusion using ICD-10 classification in the 2016–2017 National Readmission Database. The type of biologic graft used and the surgical method were both gathered. Patients were divided into groups based on how many levels had been fused. At 30, 90, and 180 days follow-up intervals, perioperative complications were gathered. Univariate testing and multivariate regression modeling were used in the statistical analysis, which considered patient demographics and comorbidities. When compared to those treated with nonautologous grafts, patients receiving single-level fusion with autologous grafts had higher rates of hardware failure (P=0.00014) at 30-day follow-up and 90-day follow-up (P<0.0001), as well as higher rates of lumbar vertebral fractures at 90-day follow-up (P=0.045). There was no difference in readmission or infection rates between patients who received lumbar fusion via anterior and posterior procedures; however, the anterior technique was associated with a higher cost. Osteoporotic patients who received autologous grafts experienced more complications than those who received nonautologous transplants. The anterior and posterior techniques showed equal complication rates, although the anterior approach had a higher overall cost.