Objective To investigate the clinical effect of “three-in-one” bone repair strategy in the treatment of osteoporotic proximal humeral fractures in elderly patients. Methods A retrospective case-control study was conducted to analyze the clinical data of 28 elderly osteoporotic patients with proximal humeral fractures treated with “three-in-one” bone repair strategy in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from Apr. 2019 to May 2020. The fracture healing time and neck-trunk angle were recorded. At the last follow-up, shoulder function was evaluated by the University of California Los Angeles (UCLA) shoulder score, bilateral range of motion and complications were observed as well. Results There were 8 males and 20 females, aged 65-86 (71.7±6.0) years. There were 10 patients with Neer’s two-part fracture, 14 three-part fracture, and 4 four-part fracture. All patients were followed up for 9-12 months, with an average of 10.5 months. Bone union was achieved in 28 patients with a mean healing time of (12.6±1.5) weeks and a mean cervix-trunk angle of (133.1±5.6)°. The average UCLA shoulder score was (31.1±4.1). The mean uplift, abduction, and external rotation angles of the injured side shoulder joint were (132.5±7.7)°, (116.5±7.0)°, and (40.3±3.5)°, and the internal rotation reached L_2/3. The mean uplift, abduction, and external rotation angles of the healthy side shoulder joint were (169.5±7.3)°, (157.5±6.9)°, and (52.1±4.2)°, and the internal rotation reached T_11/12. The difference of range of motion between the 2 sides was statistically significant (P＜0.05). Screw cut-out occurred in 1 patient, with a complication rate of 3.6%. Conclusion For the elderly patients with osteoporotic proximal humeral fracture, “three-in-one” bone repair strategy shows high bone union rate, low surgical complication rate, good recovery of shoulder joint function, and satisfied clinical results.