〔Abstract〕 Objective To analyze the correlation between vitamin D and vitamin K2 levels and bone mineral density and clinical efficacy in senile patients with osteoporotic fracture (OPF). Methods Retrospective analysis was performed on the data of elderly patients with OPF who received treatment in Nanyang Orthopedic Hospital from January 2020 to January 2022. 63 patients received conventional postoperative treatment were included in the control group, and 63 patients receiving vitamin D, vitamin K2 and calcitriol in addition to conventional postoperative treatment were included in the observation group. The clinical efficacy and fracture healing time of the two groups were compared, and the bone metabolism indexes, bone mineral density, serum vitamin D and vitamin K2 levels before and after treatment were observed to analyze the correlation. Results After treatment, the Oswestry disability index (ODI) score of the observation group was lower than that of the that of the control group, the fracture healing time was shorter than that of the control group, the bone mineral density, vitamin D, vitamin K2 and bone metabolism indexes were better than those of the control group, the differences were statistically significant (P < 0.05). According to Pearson correlation analysis, the levels of vitamin D and K2 were negatively correlated with ODI score, fracture healing time and alkaline phosphatase (ALP), and positively correlated with bone mineral density, osteocalcin (BGP) and bone morphogenetic protein-2 (BMP-2), while vitamin D was positively correlated with vitamin K2. Conclusion Vitamin D and vitamin K2 levels are clearly correlated with bone mineral density, clinical efficacy and bone-related bone metabolism indexes in elderly OPF patients. Supplementation of vitamin D and vitamin K2 can help improve clinical efficacy and enhance bone mineral density in patients.