Objective To study the characteristics of TCM syndrome elements and tongue image in senile osteoporosis with intertrochanteric fracture. Methods 154 inpatients in our hospital were selected to collect the TCM syndrome types and syndromes and baseline data, including age, gender, etc. Microsoft Excel was used to analyze the tongue image of patients and the distribution of syndrome types and symptoms. SPSS20.0 and SPSS Modeler 18.0 were used for cluster analysis and correlation analysis. Results Among 154 patients with senile osteoporosis and intertrochanteric fracture, there were 57 males (37.01%) and 97 females (62.99%). The frequency distribution of TCM syndrome types from high to low were kidney Yang deficiency syndrome(33.12%), liver and kidney deficiency syndrome(27.92%), spleen Yang deficiency syndrome (19.48%), spleen and kidney Yang deficiency syndrome (14.29%), Qi stagnation and phlegm obstruction syndrome (2.60%) and phlegm and blood stasis syndrome(2.60%). There were 373 frequency of TCM location of syndrome elements, including kidney (116/31.10%), spleen (52/13.94%) and liver (43/11.53%). The pathogenic syndromic elements included Yang deficiency (103/27.61%), Yin deficiency (43/11.53%), Qi stagnation (4/1.07%), phlegm (8/2.14%) and blood stasis (4/1.07%). Ten factors of tongue image that frequency ≧50 times: soft withered tongue, white moss, hypoglossal veins mauve, moist tongue, reddish tongue, tender tongue, dry tongue, hypoglossal veins mauve black, peeling moss, less moss; The cumulative occurrence of 756 frequency, the contribution percentage is 70.13%. The top three supporting degrees of association rules analysis are: moistening tongue, prickling tongue and greasy coating. Tongue coating moistened and punctured tongue and pale tongue; The tongue is moist and prickly and the tongue is pale and greasy. It is suggested that deficiency, blood stasis and phlegm are pathological factors. Cluster analysis of 9 categories, C1: soft withered tongue, hypoglossal vein lavender, light red tongue, tongue coating dry; C2: dark tongue, white moss; C3: thin uvula, red tongue, no moss; C4: tender tongue, varicose sublingual veins, gray and black moss; C5: fat tongue, cracked tongue, tongue coating slippery; C6: yellow moss, sublingual vein purple black, Jiang tongue; C7: pale white tongue, little moss, teeth marks tongue; C8: greasy moss, thick moss; C9: Point thorns tongue, tongue coating embellish. It is consistent with the analysis results of association rules. Conclusion The TCM location of syndrome elements of senile osteoporosis with intertrochanteric fracture include kidney, spleen and liver. The pathogenic syndromic elements include Yang deficiency, Yin deficiency, Qi stagnation, phlegm and blood stasis. The patient‘s tongue image has a certain law; Tongue embellish and punctate tongue, pale white tongue, greasy moss is a common combination of tongue; The results of tongue image study suggested that Qi(Yang) deficiency, phlegm dampness and blood stasis were the main pathogenesis.