The effect of osteoporosis on clinical outcomes following surgical treatment of intertrochanteric hip fractures was investigated. A total of 80 patients aged 65 - 97 years with intertrochanteric hip fractures underwent insertion of a proximal femoral nail. Osteoporosis severity was measured using the Singh index in the unaffected hip. Screw cut-out occurred in four patients, reverse Z-effect in three patients and Z-effect in one patient. Four patients were lost to follow up. Clinical results were evaluated according to the Harris hip scoring system. The mean Harris hip score was 73.58 (range 25 - 100). When divided according to Singh index grade (I - II versus III - V), there were no significant differences in mean age, type of fracture, American Society of Anesthesiologists classification or frequency of technical failures between the two groups. The mean Harris hip score, however, was significantly lower in patients with grades I - II compared with grades III - V, suggesting that the presence of osteoporosis had a negative effect on clinical outcome after hip fracture.