OBJECTIVES: To evaluate osteoporosis in acute trauma situations, we compared reliability of Singh index values with bone mineral density in female patients older than 65 years with proximal femur fractures. MATERIALS AND METHODS: We enrolled 145 patients who treated between June 2006 and May 2011. The radiograph was done and assessed by 3 observers to determine Singh index values. The reliability of Singh index was expressed in terms of intraobserver and interobserver agreements using Fleiss's overall Kappa values, Pearson correlation coefficients, Kendall's Tau-b values. Correlation of bone mineral density and Singh index was measured using linear by linear association. RESULTS: Kappa values for intraobserver agreement ranged from 0.361 to 0.454. Kappa values for interobserver agreement ranged from 0.325 to 0.423 neither did not reach good reliability overall. There was no statistically significant correlation between Singh index and bone mineral density. CONCLUSIONS: Singh index is inappropriate method for clinic and research work due to poor interobserver agreement, though it is a simple and inexpensive method of assessing the osteoporosis in acute trauma patients.