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The effects of visceral fat on osteoporosis have attracted considerable attention. The Chinese visceral adiposity index (CVAI) has been demonstrated to respond more effectively than conventional measures in reflecting visceral fat characteristics in the Chinese population. This study aimed to explore the relationship between CVAI and bone mineral density (BMD), FRAX scores, and osteoporosis in Chinese elderly individuals with hypertension. The datasets from the People's Hospital of Xinjiang Uygur Autonomous Region from January 2021 to December 2023 were utilized in a cross-sectional investigation. The Chinese version of FRAX scores was employed to assess the probability of a major osteoporotic fracture (MOF) or hip fracture (HF) over a 10-year period in participants. Furthermore, linear and logistic regression models were employed to investigate the relationship between CVAI and BMD, FRAX scores, and osteoporosis, while adjusting for potential confounding variables. The final analysis encompassed 850 elderly hypertensive participants, with a mean age of 67.21 years. Our multivariate linear regression models revealed a robust positive correlation between the CVAI and BMD, signifying that higher CVAI values were significantly associated with greater BMD. Conversely, these models also demonstrated an inverse relationship between CVAI and FRAX scores, suggesting that an elevated CVAI is linked to a reduced 10-year risk of MOF and HF. Furthermore, logistic regression analysis confirmed an inverse correlation between CVAI and the prevalence of osteoporosis, indicating that participants with higher CVAI had a lower likelihood of osteoporosis. Our findings indicate that an elevated CVAI is significantly associated with higher BMD, lower FRAX scores, and a reduced risk of osteoporosis among the elderly hypertensive population. These results warrant further investigation to elucidate the underlying causal mechanisms linking CVAI, BMD, and osteoporotic fracture risk.