Osteoporosis (OP) is a systemic metabolic disease characterized by disrupted bone homeostasis.Bone defects caused by OP are difficult to repair owing to an imbalanced bone microenvironment. Traditional therapies have limited efficacy, numerous complications, and complex treatment procedures. Hydrogel scaffolds have emerged as novel repair materials owing to their excellent biocompatibility and unique network structure, which can repair osteoporotic bone defects by promoting angiogenesis and regulating immune responses. This review systematically summarizes the development status and therapeutic mechanisms of hydrogel scaffolds in repairing osteoporotic bone defects, and discusses their application prospects and limitations. Multi-material hydrogel systems can facilitate the osteoporotic bone defect repair through intelligent environmental responses and diverse bioactive molecules or cell delivery, representing an ideal therapeutic strategy. Future research may focus on advancing the functional modification and clinical translation of hydrogels, and provide new directions and insights for basic research and clinical treatment of osteoporotic bone defects through in-depth investigations into their mechanisms of action.