〔Abstract〕 Objective To analyze the effect of Bushen Jiangu decoction in the treatment of osteoporotic thoracolumbar compression fractures in the elderly while receiving western medicine. Methods 90 elderly patients with osteoporotic thoracolumbar compression fractures treated in the 900th Hospital of the PLA Joint Logistic Support Force from December 2017 to December 2020 were selected and divided into a control group and a observation group, with 45 cases in each group. The control group included patients treated with western medicine, and the observation group included patients treated with Bushen Jiangu decoction combined with western medicine. The clinical efficacy, spinal canal occupation rate, anterior vertebral height and Cobb angle were compared between the two groups. Results The total effective rate of the observation group was 95.56%, higher than 82.22% of the control group, the difference was statistically significant (P < 0.05). After treatment, the rate of spinal canal invasion in the observation group was lower than that in the control group, the height of anterior vertebral margin was higher than that in the control group, and the Cobb angle was lower than that in the control group, with statistically significant differences (P < 0.05). Conclusion The treatment of osteoporotic thoracolumbar compression fractures in the elderly patients combined with Bushen Jiangu decoction can improve the condition of thoracolumbar spine and improve the treatment effect.