OBJECTIVES: To analyze the surgical results of distal femur fracture in patients over 65 years old with osteoporosis using locking compression plate. MATERIALS AND METHODS: From July 2004 to June 2010, among the patients over 65 years old with osteoporosis who underwent internal fixation using locking compression plate for distal femur fracture, 21 patients that were able to follow up for at least 2 year (mean; 19 months, range; 13~35 months) were included in this study. The mean age was 75.6 (range, 65~88), mean T-score on BMD was -4.1 (range, -3~-6.1), and sex ratio was 4 to 17, male to female. The interval from surgery to bone union and complications such as infection, nonunion, shortening, angulation, and metal failure were investigated. Neer functional scoring was used for evaluation parameter of clinical function. RESULTS: Mean duration until bone union was 19 weeks (range, 16~24) and nonunion occurred in 1 case. Complications such as infection or shortening, angulation, or metal failure did not occur. No significant relationship was found between the degree of osteoporosis (T-score) and duration until bone union (P>0.05). Neer score was 76.5 points (range, 58~94) on average, which consisted of 4 cases of excellent, 13 cases of satisfactory, and 4 cases of unsatisfactory. CONCLUSIONS: Distal femur fracture in elderly patients with osteoporosis, which bone union is difficult to achieve, locking compression plate shows less complication and excellent osteosythesis. Since on the final follow up, mostly, clinical results were satisfactory, so that it is considered a effective surgical treatment.