Background <p>Humerus shaft osteoporotic fractures are common in the elderly due to higher fall risk and osteoporotic bone, 80% of these fractures in &gt;60 years age group occur in women. Low energy fractures have high union rates and reasonable function with nonoperative treatment. Less commonly, the osteoporotic patient may sustain polytrauma, high energy injury or open injury to the arm.</p> Surgery for Osteoporotic Humerus Fractures <p>Surgery is indicated in morbid obesity, poor patient compliance, segmental or displaced fractures, open injury, radial nerve injury, polytrauma, and failure of non-operative treatment to maintain acceptable reduction. The fracture is reduced and stabilised with suitable implant to facilitate early functional improvement while maintaining the fracture reduced and stable, as it unites. Radial nerve injury is associated with humerus shaft fractures more common with distal third shaft fractures. Initial treatment is usually observation. Surgery is indicated if the nerve injury is associated with open fractures, high-energy injuries, or if nerve function is lost after closed reduction.</p> Summary <p>The surgical options for reduction and stabilisation, choice of implants and surgical approaches (interlocked nailing—antegrade or retrograde, and plating—DCP or locking plates) with inter-se merits and demerits is discussed as there is no clear superiority of one method over the other, along with measures to minimise risk of adverse events. The management of significant challenges with non-unions and peri-implant humerus shaft fractures in osteoporotic bone are outlined.</p>