The stability of screw constructs is of considerable importance in determining the outcome, especially in spinal osteoporosis. Polymethylmethacrylate (PMMA) has been proven as an effective material for increasing the pullout strength of pedicle screws inserted into the osteoporotic bones. However, PMMA has several disadvantages, such as its exothermic properties, the risk of neural injury in the event of extravasation, and difficulties in performing revision surgery. In the current study, we used hydroxyapatite (HA) cement for screw augmentation in spinal osteoporosis. We conclude that HA cement is a useful tool for screw augmentation and recommend it as a promising option for spinal instrumentation in osteoporotic patients.