One hundred forty-six patients with osteoporotic vertebral compression fractures undergoing percutaneous kyphoplasty were randomized to receive intravenous tranexamic acid (1g, n=75) or placebo (n=71). The primary outcome was hidden blood loss (HBL) on postoperative days 1 and 3. Secondary outcomes included hemoglobin and hematocrit changes, VAS pain scores, and postoperative complications. Outcomes were assessed up to one month postoperatively. Overall, the results of the study revealed that TXA significantly reduced HBL on both POD1 and POD3, and improved early postoperative pain scores without increasing the rate of complications. These findings suggest that intravenous TXA is effective and safe for reducing HBL and early postoperative pain in this patient population.