Objective To compare the effect of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) in the treatment of intertrochanteric fracture in elderly patients with osteoporosis. Methods A total of 72 elderly patients with intertrochanteric fractures were enrolled between December 2011 and December 2014. According to the different surgical methods, the patients were divided into PFNA group (38 cases) and DHS group (34 cases). The operation time, perioperative blood loss, postoperative weight-bearing time, Harris score were compared between the two groups. Results All cases were followed up for 5–24 months (mean, 13.5 months). The operation time in PFNA group was shorter than that in DHS group [(40.25±24.23) vs. (72.65±34.65) minutes], the perioperative blood loss in PFNA group was less than that in DHS group [(136±56) vs. (256±102) mL], the postoperative weight-bearing time in PFNA group was earlier than that in DHS group [(5.24±4.52) vs. (15.69±6.78) days], and the Harris score in PFNA group was higher than that in DHS group (80.23±10.26 vs. 54.75±12.37) ; the differences above were all statistically significant (P<0.05). Conclusion Elderly patients with intertrochanteric fracture and osteoporosis treated with PFNA have shorter operation time, less wounds, better hip function, and earlier weight-bearing than the patients treated with DHS; the surgical method can improve the patient′ life quality.