Osteoporotic hip fractures is a severe complication of osteoporosis and a concern for clinicians. Traditional evaluation of bone mineral density (BMD) is widely used in clinical work for osteoporosis. The cortical thickness can be conveniently obtained through routine examination, which is a significant parameter for predicting hip fractures. Meanwhile, with the combination of cortical thickness, bone mineral density, femoral anatomic structure and multiple biochemical indexes, the accuracy rate of predicting hip fractures is well improved. BMD is also very important in the bone quality evaluation, the choice of internal fixation and stability of inner plant in the treatment of hip fractures. Cortical thickness is efficacy to assess the antiosteoporosis therapy and postoperative recovery. This paper summarize current research status and the development of cortical thickness.