Summary Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10–30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500–1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem. Purpose Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries. Methods We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009–2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures. Results All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women. Conclusion Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-022-06657-8.