Background <p>Taiwan is transitioning into a super-aged society, and osteoporosis has emerged as a major public health issue, especially among culturally distinct populations like the Hakka. This study aimed to investigate the prevalence and risk factors of osteoporosis and osteoporotic fractures among aging Hakka women.</p> Methods <p>This retrospective study enrolled 779 Hakka women aged ≥ 50&#xa0;years who underwent dual-energy X-ray absorptiometry at lumbar spine and hips. Medical records were used to identify fragility fractures.</p> Results <p>Osteoporosis prevalence was 40.9% in this aged Hakka population, with lumbar spine involvement being most common. Fragility fractures were present in 44% of participants, with vertebral fractures being most common. Lower hip bone mineral density, older age, and lower weight were associated with increased fracture risk.</p> Conclusions <p>Osteoporosis and fragility fractures are highly prevalent in older Hakka women. Hip bone mineral density is the strongest predictor of fragility fractures in aged Hakka women. Targeted screening and culturally sensitive prevention strategies are urgently needed to address bone health disparities in aging ethnic populations.</p>