Background. Fractures of the odontoid peg are one of the commonest cervical spinal injuries in the elderly population. In this population there is a higher risk of morbidity and mortality as a result of the injury. The magnitude of the mortality risk has not been quantified in the literature. Aim. To show a survivorship analysis in a cohort of elderly patients with odontoid peg fractures. Method & Materials. A 6-year retrospective analysis was performed on all patients >65 years old with isolated odontoid peg fracture. Kaplan-Meir curve was used to estimate survivorship from the date of fracture. Results. A total of 32 patients witha mean age of 82.1 years were analysed. There were 17 male and 15 female with an average follow-up of 20.4 months. A low velocity mechanical fall was the commonest cause for the injury in 93.7% of cases. 81% of cases were treated with rigid collar immobilsation. Overall, it was estimated that only 62.5 % would be alive by one year. The period of greatest mortality was within the first 12 weeks, a lesser contribution from then to one year, and had no impact on mortality thereafter. Multivariate logistic regression demonstrated that age (P= 0.02) was significant factor with an odds ratio of 1.2. There was no significant relationship among gender or treatment with the occurrence of an adverse event. Conclusion. We observed a 3 month and one year mortality rates of 255 and 37.5% respectively. Odontoid peg fractures in the elderly are not benign injuries and are a cause of high mortality rates within the first three months of the injury. Patients who survived to one year following the injury were observed to have their risk return to age and sex matched rates for this population