51 patients with a displaced fracture of the femoral neck and scheduled for treatment with hemiarthroplasty were randomized to surgery completed through either an anterolateral approach or a direct lateral approach. The purpose of this study was to examine if the use of an anterolateral approach led to significantly smaller loss of periprosthetic bone mineral density when compared to the direct lateral approach. Follow-up using dual-energy x-ray absorptiometry was performed at 3 months and 6 months postoperatively. Results at 3 and 12 months demonstrated smaller total BMD reduction in the anterolateral group. When assessed by Gruen zones, significant differences between groups were noted in zones 1, 2, 6, and 7 at 3 months, and zone 6 alone at 12 months.