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Objective: To investigate the clinical efficacy of joint replacement and internal fixation in the treatment of elderly osteoporosis complicated with femoral intertrochanteric fracture. Methods: A total of 96 elderly patients with osteoporosis complicated with femoral intertrochanteric fracture, who were treated in Guangrao People’s Hospital from December 2011 to December 2014, were randomly divided into control group and experiment group. The control group was treated with internal fixation, while the experiment group, with joint replacement. The clinical efficacy, the incidence of complications and the bone density of two groups were compared.Results: The time of getting off the bed and the incidence of complications of the experiment group were obviously shorter and lower than those of the control group(P<0.05). The optimal and good rate of experimental group(95.83%) was significantly better than that(70.83%) of control group(P<0.05). Bone density of the two groups after treatment were higher than before treatment(P<0.05), and the bone density of experimental group after treatment was higher than that of the control group(P<0.05). Conclusion: Joint replacement has a better clinical efficacy than internal fixation in the treatment of elderly osteoporosis complicated with femoral intertrochanteric fracture,which can significantly reduce the incidence of complications, increase bone density, and improve the prognosis of patients. [ABSTRACT FROM AUTHOR]