Objective：To compare the clinical efficacy of bipolar femoral head replacement for intertrochanteric fracture （accompanied Kirschner wires tension band fixation） and femoral neck fracture in eldly and osteoporotic patients. Methods：Bipolar femoral head re-placement combined with Kirschner wires tension band fixation was applied for 132 elderly patients with intertrochanteric fracture and sin-gle bipolar femoral head replacement was used for 135 elderly patients with femoral neck fracture from January 2004 to December 2010. All patients were diagnosed as severe osteoporosis according to the WHO classification.The operating time，blood loss，post-operative am-bulation time，hospital duration，complication during perioperative period and follow-up，Harris score and SF-12 score were compared. Results：All the incisions healed by the first intension postoperatively. A total of 112 cases in intertrochanteric fracture group and 118 cases in femoral neck fracture group were followed-up for 2-5 years successfully，averaged 3.1 years. The operating time of in－tertrochanteric fracture group was significantly longer than that of femoral neck fracture group（Z=13.003，P=0.000） and there was no difference in the other indicators above between two groups（P >0.05）. Two patients in intertrochanteric fracture group and 3 patients in femoral neck fracture group died at 1 month postoperatively；but there was no statistical difference in complication and death inci－dences between two groups（P >0.05）. There was no significant difference in Harris score and SF-12 score at 1.5 months and 2 years postoperatively（P >0.05）. Conclusion：Bipolar femoral head replacement combined with Kirschner wires tension band fixation is effec－tive for intertrochanteric fracture in eldly and osteoporotic patients；its efficacy is similar to that of hip replacement for femoral neck fracture；therefore deserves clinical expansion.