Objective To evaluate the clinical efficacy of proximal femoral nail antirotation (PFNA) internal fixtion combined with normalized anti-osteoporosis drugs in treating elderly patients with osteoporotic femoral intertrochanteric fractures. Methods Seventy-eight elderly osteoporosis patients (≥60 years old, 25 males and 53 females) with femoral intertrochanteric fractures were enrolled, who received PFNA operation from Jun. 2012 to Jun. 2014 and had complete follow-up data. Patients were divided into anti-osteoporosis treatment group and control group according to whether anti-osteoporosis treatment was given. Patients in anti-osteoporosis treatment group (n=40) were treated with PFNA and received salmon calcitonin and zoledronic acid for sequential therapy based on the supplementation of calcium and active vitamin D, while the control group (n=38) was treated with PFNA only. Bone healing was observed with X-ray and bone mineral density (BMD) was measured regularly by dual energy X-ray absorptiometry after surgery. Harris score was used to evaluate the function of hip joint, and the complications, adverse reaction and subsequent fragility fractures were recorded after surgery. Results All patients were successfully operated, without any complication such as infection and internal fixation failure. X-ray results confirmed that clinical bone healing was achieved in all cases. There were no significant differences in fracture healing time or Harris' hip functional score between the two groups. BMD of contralateral hip joint of patients in the anti-osteoporosis treatment group was significantly higher than that in the control group on the 6 months, 12 months and 18 months after surgery (P<0.05), while the subsequent fragility fracture rate was significantly lower (P<0.05). Conclusion Method for treating elderly patients with osteoporotic femoral intertrochanteric fractures by PFNA conforms to concept of minimally invasive, with simple operation and satisfactory effect. PFNA combined with normalized anti-osteoporosis drugs can increase BMD and reduce subsequent fragile fractures.