Background: Acupoint injection has currently received increasing attention as a treatment for primary osteoporosis (POP), This study aimed to evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP. Methods: Randomized controlled trials (RCTs) of acupoint injection compared with conventional non-acupoint injection for POP were identified in searches of seven databases from their inception to March 2019. All data were assessed and extracted by two authors independently. The risk of bias assessment recommended by the Cochrane Collaboration was used to assess the quality of the selected studies. RevMan 5.3 was used to conduct meta-analysis for the efficacy and safety of acupoint injection. Results: Five trials with 337 patients (aged 45–86 years) with bone mineral density (BMD) ≤2 SD were included in our meta-analysis. The results showed that, compared with conventional intramuscular injection, acupoint injection significantly increased the BMD [mean difference (MD) =0.02; 95% CI, 0.01 to 0.03, P<0.00001]. Subgroup analysis indicated that acupoint injection significantly improved lumbar BMD (MD =0.02; 95% CI, 0.01 to 0.03, P<0.00001) but did not reduce the pain score (SMD =−2.29, 95% CI, −6.81 to 2.23, P>0.05). Individuals results showed that acupoint injection improved biochemical indicators, such as NBAP, IGF-I and reduced CTX and leptin levels. While the risk of bias was high in all five trials. Conclusions: This meta-analysis and systematic review suggests that acupoint injection improves BMD and some biochemical indicators in POP patients compared with the effects of conventional intramuscular injection. However, due to the high risk of bias in all the trials reviewed, the evidence remains inconclusive and future research will be required with improved methodological quality.