The direct anterior screw fixation of odontoid fractures by a single cancellous screw, especially for osteoporotic vertebrae, has a potential risk of leading to insufficient stability and implant failures. We experienced good results following surgery using a single Acutrak 4/5 screw to obtain sufficient stability for an odontoid fracture in a patient with osteopenia. The screw is a cannulated self-tapping headless screw and has a tapered profile and full threads with variable pitches, and it can yield sufficient compression force as the screw is inserted. The preoperative severe neck pain of the patient was diminished immediately after the surgery. The patient achieved bone union in a short time and had a good clinical result for at least 3 years. Some biomechanical studies showed that the compression force of Acutrak standard screws was stronger than that of both 4.0-mm cancellous screws inserted with the lag screw technique and Herbert screws, and other studies showed that the compression force of Acutrak 4/5 screws was equivalent to that of 4.5-mm cortical screws. However, there has been no clinical report of surgery using an Acutrak 4/5 screw for odontoid fractures. This is the first clinical report of fixation by an Acutrak 4/5 screw.