OBJECTIVE： To compare the efficacy and safety of alfacalcidol and strontium ranelate in the treatment of senile menopausal osteoporosis. METHODS： 158 elderly menopausal patients with osteoporosis were randomly divided into control group （79 cases） and observation group（79 cases）. All patients were orally given 1 Calcium carbonate D3 tablet， once a day. Based on it， control group was given 2 Alfacalcidol soft capsules， once a day. Observation group was additionally given 1 bag of Strontium ranelate dry suspension， orally before bedtime， once a day. The treatment course for both groups was 12 months. L2-4 and BMD of femoral neck， osteocalcin，TPINP and VAS and ADR before and after 6 and 12 months in 2 groups were observed. RESULTS： Before treatment， there were significant differences in the BMD of L2-4 and femoral neck， osteocalcin， TPINP and VAS scores between 2 groups （P＞0.05）. BMD of L2-4 and femoral neck in control group after 12 months and in observation group after 6 and 12 months were significantly higher than before， and it gradually increased be time in observation， observation group was higher than control group； TPINP and VAS scores in control group after 12 months and in observation group after 6 and 12 months were significantly lower than before， and it gradually decreased be time， observation group was lower than control group， the differences were statistically significant （P＜0.05）； osteocalcin levels in 2 groups were significantly higher than before， and it gradually increased be time， the difference was statistically significant （P＜0.05）， but there was no significant difference between 2 groups （P＞0.05）. There were no ADR during treatment. CONCLUSIONS： Based on the conventional treatment， the efficacy of alfacalcidol and strontium ranelate is superior to alfacalcidol alone in the treatment of senile menopausal osteoporosis， with similar safety.