Objective:To analyze the application value of three-dimensional computed tomography (3-D CT) reconstruction technique in the evaluation of related predictive parameters of osteoporotic hip fractures.Methods:From February 2014 to March 2019, 106 patients with hip fracture who underwent dual-energy X-ray bone density test of T≤ -2.5 SD on the hip were analyzed retrospectively. There were 58 males and 48 females; Age 73.50±5.59 years old (range, 65-88 years old); Height 170.12±7.43 cm (range, 152-187 cm); Weight (69.26±11.85) kg (range, 37-94 kg); Body mass index 23.60±2.37 kg/m 2 (range, 18.3-28.9 kg/m 2); There were 32 cases of femoral neck fractures, 68 cases of intertrochanteric fractures and 6 cases of subtrochanteric fractures. Anatomic parameters of the hip were the cortical thickness index (CTI), hip axis length (HAL), and femoral offset (FO). The above-mentioned predictive parameters of the hip fractures were measured based on X-ray and 3-D CT reconstruction images. Comparison of the two methods were analyzed using paired t test, liner Pearson analysis, and Bland-Altman analysis. Pearson analysis was used to evaluate correlation between CTI, HAL, and FO and T value. Results:106 cases were compared and analyzed with the measured values of X-ray and 3-D CT reconstruction images according to the preset measurement scheme. The mean value of CTI measured by conventional X-ray measurement method was 0.31±0.05, and the mean value of CTI measured by 3-D CT reconstruction images was 0.31±0.05. The result was not statistically significant ( t=0.938, P=0.35). The mean values of HAL, FO measured by conventional X-ray measurement method were 123.35±12.74 mm, 43.99±2.81 mm, and the mean values of HAL, FO measured by 3-D CT reconstruction images were 121.11±14.51 mm, 40.73±3.11 mm. The results were statistically different ( t=2.578, 18.502; all P< 0.05). The Bland-Altman results showed that there was no difference in the consistency of the two measurement methods for CTI while the measurement results of HAL, FO were quite different. CTI and HAL showed strong correlations with the T scores respectively ( r=0.784, -0.748; P< 0.001). Conclusion:Based on 3-D CT reconstruction technique, accurate measurement of related predictive parameters of osteoporotic hip fractures can be realized, which provides theoretical basis for the evaluation of osteoporotic hip fractures in the elderly and the formulation of accurate rehabilitation treatment plan.