Background <p>Osteoporosis and osteopenia have been identified as risk factors for audio-vestibular dysfunction in postmenopausal females, but it is not established yet whether osteoporosis can produce the same effects in females in the reproductive period or not. So, we aimed to study the audio-vestibular changes in females with osteoporosis in the reproductive and postmenopausal period too and compare them.</p> Methods <p>This prospective, case–control study included 136 patients. Subjects in this study were divided into 2 groups: group 1 (Reproductive group) and group 2 (Postmenopausal group). Each group was further subdivided to control and study subgroups. Subjects in the current study were submitted to the following: audio-vestibular history taking, otoscopic examination, office tests for vestibular assessment, audio-vestibular evaluation tests (pure tone audiometry, tympanometry, vestibular evoked myogenic potentials and video head impulse test), dual x-ray absorptiometry (DEXA) scan, and laboratory investigations including serum calcium and vitamin D.</p> Results <p>Both reproductive and postmenopausal osteoporotic females had higher hearing thresholds than the controls in the frequency range of (500–8000&#xa0;Hz) (<i>P</i> &lt; 0.05). N1&amp; P1 latency changes were reported in ocular and cervical vestibular evoked myogenic potentials (<i>P</i> &lt; 0.05). Significant differences between the control and study subgroups in the reproductive and postmenopausal women were reported regarding serum calcium, vitamin D, and dual x-ray absorptiometry scan. Little effect of osteoporosis was noted in video head impulse as abnormal results were reported in 3% and 9% of ears in the reproductive and postmenopausal osteoporotic females respectively.</p> Conclusion <p>Osteoporosis in the reproductive and postmenopausal females can cause hearing impairment and otolith dysfunction with little effect on semicircular canal function.</p>