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Objective:To evaluate the efficacy and safety of rhPTH(1-34)vs. elcatonin.Methods:Sixty patients with primaryOP were randomly divided into two groups according to the ratio of3:1. rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34)20 μg daily for18 months, and the elcatonin group(CT group) was treated with intramuscular injection of elcatonin20U weekly for12 months.Bone mineral density(BMD) of the lumbar spine2-4(L2-4) and femoral neck, serum calcium and phosphorus, urinary calcium, serum bone specific alkaline phosphatase(BSAP), and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ/Cr) were tested at baseline, and6,12, and18 months after treatment.Results:InPTH group, BMD ofL2-4 at6,12, and18 months,BDM of femoral neck at18 month,BSAP at6 and12 months and uCTX-Ⅰ/Cr at6,12 and18 months were all significantly raised.InCT group,BMD ofL2-4at 12 month and that of femoral neck at12 and18 months were significantly elevated, whileBSAP was significantly decreased at12 and18 months, and no significant difference onCTX-Ⅰ/Cr was observed.WhenBMD growth and growth rate between two groups were compared,PTH group had better improvement inL2-4BMD and growth rate thanCT group at6,12, and18 months.BMD growth and growth rate of femoral neck at12 month and its growth at18 month inCT group were higher than inPTH group, but there was no significant difference between two groups regarding the growth rates at18 month.Besides, there were no significant differences regarding the rates of adverse reactions between two groups.Conclusions: rhPTH(1-34), is safe and effective in the treatment of primaryOP.It is superior to elcatonin in improving vertebralBMD at onset time, growth rate and growth range, but inferior to elcatonin atBMD of femoral neck.