Purpose <p>Vertebral fractures (VFs) cause substantial pain and disability. Epidemiological data are essential for guiding prevention and control, yet evidence in female populations remains limited. This study assessed the global burden and trends of VFs among women using the 2021 Global Burden of Disease database, with emphasis on sex-specific disparities.</p> Methods <p>We evaluated incidence, prevalence, and years lived with disability of VFs in females across regions, age groups, and periods, along with age-standardized rates. Joinpoint regression, age–period–cohort models, frontier analysis, and correlation analyses were applied to delineate temporal and regional patterns, quantify risk drivers, and project future trends.</p> Results <p>From 1990 to 2021, the absolute burden of female VFs increased, while age-standardized rates declined and are projected to continue decreasing. VFs incidence exceeded that of males after age 65. Australasia, High-income North America, and Western Europe bore the heaviest burdens. Between 1990 and 2021, VFs burden rose steadily in low socio-demographic index (SDI) regions, accelerated when SDI exceeded 0.6, and plateaued then declined above 0.85. Joinpoint regression indicated an overall downward trend with fluctuations. Age–period–cohort analysis revealed declining period-specific risks, and incidence risk significantly increased beyond age 42.5 years. Falls were the predominant cause (69.6%) with rising contributions, while low bone mineral density showed a strong association with both VFs and falls.</p> Conclusions <p>Despite declining standardized rates, the absolute number of female VF cases continues to grow, demanding urgent attention. Postmenopausal women should be prioritized, with fall prevention and osteoporosis management offering substantial benefits. Regional and demographic disparities underscore the need for targeted strategies to mitigate the global VF burden and improve outcomes.</p>