Abstract: Objective To investigate the effects of Cervus and Cucumis Polypeptide Injection combined with Chinese herbal fumigation on bone metabolism, lumbar function, and refracture rate in elderly patients with osteoporotic thoracolumbar fractures (OTF) after percutaneous kyphoplasty (PKP). Methods A total of 168 elderly OTF patients who underwent PKP at Harbin Second Hospital from January 2022 to March 2024 were enrolled. They were divided into four groups using a random number table: a conventional group of 42 cases (receiving routine postoperative treatment), a Cervus and Cucumis Polypeptide group of 42 cases (receiving routine treatment plus Cervus and Cucumis Polypeptide treatment), a Chinese herbal fumigation group of 42 cases (receiving routine treatment plus Chinese herbal fumigation treatment), and a combination group of 42 cases (receiving routine treatment plus Cervus and Cucumis Polypeptide injection plus Chinese herbal fumigation treatment). Bone metabolism, lumbar function, biomechanical indicators, refracture rate, and incidence of complications were compared among the groups. Results One week after surgery, the serum levels of bone-specific alkaline phosphatase (BALP), osteocalcin (OCN), bone morphogenetic protein-2 (BGP-2), and lumbar bone mineral density in the combination group were higher than those in the other groups (P ＜ 0.05). The relative anterior height of the injured vertebra in the combination group was greater, and the Cobb angle measured for spinal scoliosis was smaller compared to the other groups (P ＜ 0.05). At both 1 week and 3 months after surgery, the combination group showed higher Japanese Orthopaedic Association (JOA) score and lower Oswestry Disability Index (ODI) than that of the other groups (P ＜ 0.05). The refracture rate in the combination group was lower than that of the other groups (P ＜ 0.05). There was no significant difference in the overall incidence of complications among the four groups (P ＞ 0.05). Conclusion For elderly OTF patients after PKP, the combination therapy of Cervus and Cucumis Polypeptide Injection and Chinese herbal fumigation can effectively improve lumbar function and bone metabolism levels, promote early functional recovery, and reduce the risk of refracture.