〔Abstract〕 Objective To investigate the effect of alendronate combined with tibolone in the treatment of postmenopausal osteoporosis (PMO) and its effect on bone alkaline phosphatase (BALP), cross-linked C-terminal peptide of type I collagen (β-CTX), 25 – hydroxyvitamin D3 [25 (OH) D3] and estradiol (E2). Methods 118 patients with PMO treated in Quanzhou Orthopaedic-Traumatological Hospital from March 2020 to January 2021 were divided into single drug group (alendronate treatment) and combined group (single drug group plus tibolone treatment), with 59 cases in each group. The clinical efficacy and bone metabolism of the two groups were observed. Results The total effective rate in the combined group was 93.22%, higher than 79.66% in the single drug group (P < 0.05); after treatment, the levels of 25 (OH) D3 and E2 in the combined group were higher than those in the single drug group, the levels of BALP and β-CTX were significantly lower than those in the single drug group (P < 0.05). Conclusion Alendronate combined with tibolone in the treatment of PMO can improve bone metabolism and clinical efficacy.