Objective: To investigate the efficacy of calcitriol (Cal) combined with elcatonin on osteoporosis (OP) and its impact on bone metabolism in patients. Methods: One hundred elderly OP patients admitted to Huairou District Traditional Chinese Medicine Hospital from June 2022 to June 2024 were enrolled as the research subjects and randomly assigned into criterion group (50 cases) and joint group (50 cases) complying with random number table. The criterion group received oral Cal soft capsules, while the joint group received additional elcatonin injection on top of the criterion group. The treatment course for both groups was 3 months, with a follow-up of 12 months. The efficacy, bone metabolism [bone alkaline phosphatase (BALP), tartrate resistant acid phosphatase (TRACP), osteocalcin (OC), type I collagen cross-linked C-terminal peptide (CTX)], bone mineral density (BMD), bone pain score, quality of life score before treatment and after 3 months of treatment, and incidence of adverse reactions were compared between the two groups. Results The therapeutic effect of the joint group was significantly better than that of the criterion group (94.00%, 70.00%, P<0.05). After treatment, the BALP, OC, BMD, and quality of life scores of both groups significantly increased compared with those before treatment, and the joint group was significantly higher than the criterion group (P<0.05). The TRACP, CTX, and bone pain scores of both groups significantly decreased compared with those before treatment, and the joint group was prominently lower than the criterion group (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). At 12-month follow-up, there was no statistically significant difference in fracture incidence between the two groups (P>0.05). Conclusion: The combination of Cal and elcatonin has good efficacy in treating OP patients. It can regulate bone metabolism indicators, effectively regulate bone metabolism, increase bone density, relieve pain and improve quality of life, and has high safety.