Abstract： Objective： To observe the clinical effect of Fuzheng Hugu Decoction combined with kyphoplasty on osteoporotic thoracolumbar fractures in the elderly. Methods：A total of 100 cases of elderly patients with osteoporotic thoracolumbar fractures were divided into the control group and the observation group according to the random number table method， with 50 cases in each group. The control group received minimally invasive surgery of kyphoplasty，and the observation group was treated with minimally invasive surgery of kyphoplasty and Fuzheng Hugu Decoction. The Visual Analogue Scale (VAS) scores， traditional Chinese medicine syndrome scores，Oswestry Disability Index，and the levels of lumbar spine bone density and bone metabolism indicators (25 hydroxyvitamin D， N-terminal osteocalcin， β-collagen special sequence， and total procollagen type ⅠN-terminal propeptide) were compared between the two groups before treatment and after one and three months of treatment. Results：After one and three months of treatment， VAS scores， traditional Chinese medicine syndrome scores， and scores of Oswestry Disability Index in the two groups were declined when compared with those before treatment (P＜0.05)， and VAS scores，traditional Chinese medicine syndrome scores，and scores of Oswestry Disability Index in the observation group were lower than those in the control group (P＜0.05). After one and three months of treatment，the levels of 25 hydroxyvitamin D and N-terminal osteocalcin in the two groups were increased when compared with those before treatment (P＜0.05)，and the levels of β-collagen special sequence and total procollagen typeⅠN-terminal propeptide were reduced (P＜0.05)；the levels of 25 hydroxyvitamin D and N-terminal osteocalcin in the observation group were higher than those in the control group (P＜0.05)， and the levels of β-collagen special sequence and total procollagen type ⅠN-terminal propeptide in the observation group were lower than those in the control group (P＜0.05). After three months of treatment， lumbar bone mineral density in the two groups was enhanced when compared with that before treatment (P＜0.05)，and the lumbar bone mineral density in the observation group was higher than that in the control group (P＜0.05). The incidence of postoperative fractures in the observation group was 2.00%，which was lower than that of 12.00% in the control group (P＜0.05). Conclusion：Fuzheng Hugu Decoction combined with kyphoplasty on osteoporotic thoracolumbar fractures in the elderly can relieve pain， regulate bone metabolism，increase bone density，and reduce the incidence of postoperative fractures