To investigate the clinical efficacy of Bushen Zhuangdu Formula combined with alendronate sodium in the treatment of osteoporotic vertebral fracture in middle-aged and elderly patients，as well as its impact on bone morphogenetic protein-2(BMP-2) and B-cell lymphoma-2(Bcl-2).Methods:Sixty-nine patients with osteoporotic vertebral fracture who were hospitalized at Haikou Hospital of Traditional Chinese Medicine from January 2019 to June 2021 were enrolled and randomly divided into an observation group(n=35) and a control group(n=34) according to a random number table.The control group received oral alendronate sodium，while the observation group received additional oral treatment with Bushen Zhuangdu Formula.The clinical efficacy of traditional Chinese medicine(TCM) syndrome was recorded in both groups.Bone density improvement was assessed using T-scores，and bone callus growth was evaluated using a bone callus growth scoring scale.Serum levels of BMP-2 and Bcl-2 were measured to assess bone growth.Results:There was a significant difference in the clinical efficacy of TCM syndrome between the two groups after treatment(P<0.05).Compared with the control group，the observation group had significantly higher T-scores of lumbar vertebrae，femoral neck，trochanter，and Wards triangle area after treatment and follow-up(P<0.05).The observation group also had significantly higher scores for fracture edge，callus density，callus volume，and callus edge after treatment and follow-up compared with the control group(P<0.05).The levels of BMP-2 and Bcl-2 were significantly higher in the observation group than in the control group after treatment(P<0.05).Conclusion:Bushen Zhuangdu Formula combined with alendronate sodium can accelerate the healing of osteoporotic vertebral fracture in middle-aged and elderly patients，improve bone density，and enhance quality of life.