<p>Sleep disorders and osteoporosis frequently co-occur in the elderly, especially among those living at high altitudes. This study aimed to investigate the association between sleep disorders and osteoporosis among elderly residents of high-altitude regions in China. We conducted a cross-sectional analysis from January 2021 to January 2023, enrolling 160 elderly participants aged 60&#xa0;years and older from high-altitude areas. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), and osteoporosis was diagnosed using dual-energy X-ray absorptiometry (DEXA). Demographic data, blood parameters, and pulmonary artery pressure were collected. Statistical analyses included descriptive statistics, correlation analysis, and logistic regression to determine the independent association between sleep disorders and osteoporosis, adjusting for potential confounders. Osteoporosis was prevalent in 65% of the participants, with 75% of those also having sleep disorders. A significant negative correlation was found between sleep quality and bone density (ρ = −0.65, P &lt; 0.001), suggesting a positive relationship between the severity of sleep disorders and the risk of osteoporosis. Multivariate logistic regression analysis revealed a significant association between sleep disorders and the presence of osteoporosis (OR = 1.67, 95% CI: 1.20–2.20, P = 0.001). Subgroup analyses showed stronger associations in females (OR = 2.20, 95% CI: 1.50–3.20, P &lt; 0.001) and participants aged over 70&#xa0;years (OR = 2.00, 95% CI: 1.30–3.10, P = 0.002). Significant correlations were also observed in participants with oxygen saturation below 85% (OR = 2.50, 95% CI: 1.60–3.90, P &lt; 0.001) and those with elevated pulmonary artery pressure (OR = 2.80, 95% CI: 1.80–4.30, P &lt; 0.001). Sleep disorders are significantly associated with osteoporosis in the elderly at high altitudes, with physiological variables in this environment potentially exacerbating this relationship.</p>