Objective: To explore the clinical curative effect of Bushen Zhuyu Decoction combined with thunder fire moxibustion in the elderly with osteoporotic low back pain. Methods: A total of 116 seniors experiencing lower back pain due to osteoporosis were selected and divided into control group (routine western medicine) and observation group (Bushen Zhuyu Decoction combined with thunder fire moxibustion on basis of control group), with 58 cases in each group. 1 treatment course lasts two weeks, with a total of 6 consecutive courses required. The clinical curative effect, scores of TCM syndromes, bone mineral density, severity of low back pain, dysfunction degree and 25-(OH)D3 levels were compared between the two groups. Results: After 3 courses of treatment, total clinical effective rate of observation group was higher than that of control group (94.83% vs. 81.03%, P<0.05). After treatment, the scores of traditional Chinese medicine syndrome, degree of functional impairment, visual analog score (VAS), bone density, and 25-(OH)D3 improved in both groups. Compared with control group, the observation group had lower TCM syndrome scores, functional impairment levels, and visual analog scores after two weeks of treatment and at the end of course (P<0.05), while BMD, 25-(OH)D3 were higher (P<0.05). Conclusion: On basis of routine western medicine, Bushen Zhuyu Decoction combined with thunder fire moxibustion can increase clinical response rate, reduce scores of TCM syndromes, improve BMD, alleviate low back pain and pain-induced dysfunction, and improve bone metabolism indexes.