Hypertension and osteoporosis are often present concomitantly in older adults. This narrative review summarizes current knowledge on the effects of hypertension on bone mineral density (BMD) and the effects of major classes of antihypertensive medications on BMD. The relationship between hypertension and BMD has been studied extensively, but remains highly controversial. Commonly prescribed antihypertensive medications, such as thiazides, beta-adrenergic blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and calcium channel blockers, have mechanisms of action through which they could potentially affect bone metabolism and BMD. The evidence supports a small positive effect of thiazides in terms of increasing BMD or preventing decrease in BMD. Studies of the effect of betaadrenergic blockers and angiotensin-converting enzyme inhibitors on BMD have shown conflicting results. Very few studies have examined the effect of angiotensin II receptor blockers on BMD, and these studies are inconclusive. Studies of calcium channel blockers have found conflicting effects on BMD. Overall, definitive conclusions cannot be reached on the effect of antihypertensive drugs on BMD other than for thiazide diuretics.