The purpose of this research is to ascertain whether or not osteoporosis affects spinal instrumentation. Osteoporosis is a major public health concern for common skeletal disease affecting systemic cortical bone preservation and remodeling. Due to the accelerated degeneration of the spine caused by this condition, spinal surgery is frequently required to treat progressive vertebral deformity, pathologic fracture, bone canal stenosis, and/or neural element decompression. Studies examining the impact of osteoporosis on perioperative complications and postoperative outcomes following spinal fusion are scarce. Spine surgery patients who were treated between January 1, 2006, and October 3, 2017, were the focus of a retrospective analysis of a prospectively maintained database. Having undergone surgery to address thoracolumbar scoliosis and being at least 18 years old were both requirements for participation. Several demographic, clinical, and surgical factors were accounted for in the obtained data. Among the 532 patients who satisfied the inclusion criteria, 144 (27%) were diagnosed with osteoporosis. Increased blood volume loss was associated with osteoporosis (P=0.003). There were more cases of instrumentation failure (19% vs. 10%; P=0.008) and revision surgery (33% vs. 16%; P<0.001) in patients with osteoporosis after surgery. Osteoporosis was found to be an independent risk factor for increased mean blood volume loss (P<0.05), increased rate of postoperative deep vein thrombosis/pulmonary embolism (P<0.05), increased rate of instrumentation failure (P<0.05), and increased need for revision surgery (P<0.05) in a multivariate analysis. Patients with osteoporosis are at increased risk for instrumentation failure and subsequent revision surgery after undergoing arthrodesis to treat scoliosis. The risk of intraoperative blood volume loss and postoperative thromboembolic events is also considerably increased in individuals with osteoporosis.