Odontoid fractures can be successfully treated with anterior screw fixation. Odontoid fractures commonly occur in older patients who may have significant osteopenia. The authors examined the use of a bone substitute to overcome limitations encountered during a procedure in which anterior odontoid screw fixation is performed. Two elderly patients with displaced, reducible acute odontoid fractures underwent anterior odontoid screw fixation. The intraoperative failure of the anterior vertebral cortex from osteopenic bone and failure to achieve complete contact between the dens and axis were encountered. The defects were supplemented by using the osteoconductive agent Norian. Outcome was evaluated to determine the utility of this method. Occasional intraoperative failure of anterior odontoid screw fixation may be encountered. Supplementation of bone defects with this osteoconductive agent may facilitate successful bone union in selected patients.