This study investigated bone marrow perfusion at proximal femur varying with bone mineral density (BMD) and aging over 4 years. Dynamic contrast enhanced MRI data was extracted pixel-by-pixel and classified into 3 patterns to indicate the perfusion function. Eighty-seven elderly females were involved. A notable reduced perfusion as a whole was observed in osteoporotic subjects. Moreover, perfusion distribution varies as BMD decreases, especially at the area crossing the femoral neck to the shaft. Consistent for all subjects, the perfusion decreases significantly from the lesser trochanter to the greater trochanter. Further, the subjects with good bone marrow perfusion would keep stable BMD after 4 years, while for those with bad perfusion, their BMD consistently decreased over 4 years. The results indicated that the bone marrow perfusion function interacts with bone modeling and could have a long term effect on BMD. A good perfusion function would help to keep the bone health.