Abstract : Osteoporosis is considered one of the diseases that is increasingly spreading worldwide accompanied by an increase in the incidence of proximal femur fractures in the elderly. The Proximal Femur Nail (PFN) is the preferred method for treating these fractures; however, the failure rate in fixing these fractures is high due to the migration of the head screw and its penetration the femoral head as a result of the loss of cohesion between the bone tissue in the femoral head and the head screw. Bone cement helps to increase the interlocking forces between the bone tissue and the head screw. This study aims to investigate the effect of cement injections on the clinical outcomes of extracapsular repair of proximal femoral fractures in elderly patients with osteoporosis. A randomized controlled clinical trial of a group of patients admitted to Al-Mouwasat University Hospital in Damascus, of both sexes and with intertrochantric fractures and who were treated with proximal femoral nail in the period from January 2022 to September 2023 with a follow-up interval of 1.5months, 3 months and 6 months. Patients were divided into Two groups according to cement augmentation. The study was completed by 84 patients distributed into 41 patients for the PFN with cement injection group (CPFN) and 43 patients for the PFN without cement injection group (NCPFN). There was no statistically significant difference before fracture between the two groups when studying the following variables: Parker Mobility Score, Salvati and Wilson Score, World Health Organization score system and Cumulated Ambulation Score. After 6 months: The mean of these variables is better in CPFN group with P-value<0.05. From our study, we find that cement injection into the femoral head helped improve the clinical outcomes of elderly patients with femoral neck fractures treated with PFN.