Background: Benign paroxysmal positional vertigo (BPPV) is a common type of vertigo involving the peripheral vestibular system. Consensus on the factors causing BPPV is limited. Due to the uncertainty of etiological factors causing BPPV, most cases are accepted as idiopathic. Calcium metabolism plays a primary role in the synthesis and absorption of otoconia primarily made of calcium carbonate and, thus, might be an etiological factor in the onset of BPPV. Objective: To study the role of osteoporosis and vitamin D deficiency in the etiology of BPPV. Study Design: Case-control study. Methods: This is a case-control study comparing the prevalence of osteoporosis and vitamin D deficiency in 100 patients diagnosed with idiopathic BPPV and 100 hospital-based controls. Mean T scores and serum vitamin D levels were compared in the two groups. The groups were substratified based on age, sex, and menopausal status in order to avoid selection bias. Results: There was a high prevalence of osteoporosis and vitamin D deficiency among the patients with BPPV (60 and 76%, respectively). Postmenopausal patients with BPPV had a significantly higher prevalence of vitamin D deficiency and osteoporosis (57 and 64%, respectively). Conclusion: The prevalence of osteoporosis and vitamin D deficiency is reasonably high in the postmenopausal population. Menopausal patients with suspected BPPV may be empirically treated with vitamin D. However, other known factors causing BPPV should be investigated, and the patients should be treated accordingly.