Objective To investigate the efficacy of Huoxue Zhuanggu formula in combination with percutaneous vertebroplasty （PVP） for the treatment of osteoporotic vertebral compression fractures （OVCF）. Methods A total of 114 patients with OVCFs were randomly assigned to three groups： the percutaneous vertebroplasty （PVP） group， the PVP group with routine postoperative treatment （55 cases）， and the Huoxue Zhuanggu formula combined with additional supportive therapy group （56 cases）. All patients received a 4-week course of treatment following surgery and were followed up for 6 months. Results After 6 months of follow-up， the total effective rate in the Huoxue Zhuanggu group was significantly higher than that in the PVP group （P < 0.05）. At 4 weeks postoperatively， serum levels of N-terminal osteocalcin， total type I collagen amino-terminal telopeptide， and β-collagen degradation product were lower in the Huoxue Zhuanggu group compared to the PVP group. Additionally， serum bone morphogenetic protein-2 levels were significantly higher in the Huoxue Zhuanggu group than in the PVP group （P < 0.05）. After 6 months of follow-up， bone mineral density in Ward's triangle， lumbar spine， and femoral neck， as well as anterior vertebral height percentage and neurological function scores， were significantly higher in the Huoxue Zhuanggu group compared to the PVP group （P < 0.05）. Conversely， the sagittal kyphosis Cobb angle， anterior vertebral height loss rate， and Oswestry Disability Index score were significantly lower in the Huoxue Zhuanggu group than in the PVP group （P < 0.05）. Conclusion The combination of Huoxue Zhuanggu recipe and PVP in the treatment of OVCF can regulate patients' bone metabolism indices， enhance bone mineral density， improve vertebral function as well as nerve and lumbar function， thereby achieving a satisfactory therapeutic effect.