Osteoporosis is a systemic metabolic bone homeostasis imbalance disease, and the bone defects caused by OP are difficult to repair due to the imbalance of bone microenvironment. The existing traditional therapies have limited effect, many complications and complicated treatment process. Hydrogel scaffold has become a new type of repair material due to its good biocompatibility and unique network structure, which can repair osteoporotic bone defects by regulating immunity and other ways. This review summarizes the development and therapeutic principles of hydrogel scaffolds in the repair of osteoporotic bone defects, and discusses the application prospects and shortcomings of these hydrogels. It is concluded that multi-material composite hydrogel systems can promote the repair of osteoporotic bone defects by intelligent response to the environment and delivery of different molecules or cells. Taking into account the advantages of natural and synthetic hydrogels, they are a better method for the treatment of osteoporotic bone defect repair. In this paper, the types and mechanisms of hydrogels for the treatment of osteoporotic bone defects are analyzed, aiming to provide new ideas for the research and treatment of osteoporotic bone defects.