Objective Meta-analysis was used to evaluate the efficacy and safety of the use of Taohong Siwu decoction in combination with rosacea on the basis of percutaneous vertebral augmentation in the treatment of osteoporotic thoracolumbar compression fractures. Methods The computer retrieved the databases of CNKI, Wanfang, Weipu and PubMed and Cochrane Library, retrieved the literature published from the establishment of the library until October 2021, and included the treatment plan of percutaneous vertebral augmentation combined with Taohong Siwu decoction compared with the randomized controlled trial using vertebral enhancement alone, and two researchers independently evaluated the literature quality according to the Cochrane manual standards, extracted the data and cross-checked, and used RevMan5.4 software for meta-analysis. Results There were 12 articles included, with a total sample size of 1145 cases. Meta-analysis results showed that the effective rate of the experimental group[OR=4.22, 95%CI(2.77, 6.43), P<0.000 01], bone density[MD=0.20, 95%CI(0.09, 0.30), P<0.000 01], bone metabolism index (BGP[MD=1.34, 95%CI(0.75, 1.93), P<0.000 01］, BALP［MD=4.69, 95%CI(4.36, 5.02), P＜0.000 01], TP1NP[MD=11.49, 95%CI(3.85, 19.13), P=0.003] was higher than the control group. VAS score in the experimental group [MD=-1.10, 95%CI(-1.52, 0.69), P<0.000 01], ODI score [MD=-6.49, 95%CI (-9.93, -3.04), P<0.000 01], Cobb angle[MD=-3.64, 95%CI(-5.67, -1.61), P<0.000 01] Indicators, postoperative complications[OR=4.22, 95%CI(2.77, 6.43), P<0.000 01] Lower than the control group, the comparison difference is statistically significant. Funnel plots of therapeutic efficiency show that studies are spread across both sides of the midline, with a more uniform distribution and lower publication bias. Conclusion Compared with pure vertebral enhancement, Taohong Siwu decoction is the main auxiliary vertebral enhancement in the treatment of osteoporotic thoracolumbar fractures in terms of improving efficiency, bone density and bone metabolism indexes, which can reduce VAS score, ODI score and Cobb angle, reduce the occurrence of postoperative complications, and thus improve the overall efficacy. However, more high-quality randomized controlled trials are needed for further validation.