To explore the clinical effect and safety of Longmu Zhuanggu Granule (Longmu Bone-strengthening Granule) in conservative treatment of postmenopausal osteoporotic vertebral compression fractures (POVCF). Methods: A total of 72 patients were randomized to Longmu Zhuanggu Granule (the treating group) or Caltrate D (the control group) to treat POVCF based on the transdermal estrogen therapy. The effective rates, VAS scores, dosages of Tramadol, bone mineral density changes and adverse events of treating group were compared with those of control group in1 month, 2 months and 3 months post-dose. And the VAS scores, OQOLS scale scores, bone mineral densities and refracture rates and adverse events were also evaluated through follow-up visits in 6 months and 1 year post-dose. Results: Every indicator of two groups had no significant differences at baseline (P>0.05) and could be comparable. There were 2 cases in either group failing to revisit at the 2nd month post-dose, and 3 cases in the treating group and 4 cases in the control group failing to take the follow-up visit in 1 year post-dose. Hence there was no significant difference of loss rates between two groups (P>0.05). At the 1 st month and the 2nd month, the effective rates, VAS scores, dosages of Tramadol and bone mineral densities of the treating group were better than those of the control group, and the differences were significant (P<0.05). However, there were no significant differences between two groups in 3 months, 6 months and 1 year post-dose(P>0.05). The OQOLS scale score of the treating group was better than that of the control group in 6 months and 1 year post-dose (P<0.05). Both groups had no adverse drug reactions, no refractures, no new hyperlipidemias, no thrombotic events, no new gallbladder diseases, no new malignant tumors during treatment. Conclusion: Longmu Zhuanggu Granule combined with transdermal estrogen in the treatment of POVCF could quickly improve bone mineral density, relieve pain symptoms and reduce the refracture rate, safe and worthy of clinical promotion.