Background Warm needle acupuncture (WNA) is commonly used in primary osteoporosis (OP) management in China. The evidence of its effectiveness needs to be systematically reviewed. Objective The aim of the meta-analysis was to evaluate whether using WNA alone or combined with conventional medicine benefits primary OP. Methods PubMed, Embase, the Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang and VIP databases were searched from their inception through 30 June 2016. RCTs applying WNA independently or as an adjunct to conventional medicine, compared with conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle and greater trochanter. The secondary outcome was chronic pain measured by VAS score. Meta-analysis was conducted using RevMan V. 5.3 software. Results Nine RCTs involving 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favour of increasing BMD of the lumbar vertebrae (mean difference (MD)= 0.06, 95% CI 0.03 to 0.08, P< 0.001). WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, P< 0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, P< 0.001) when used alone, and additionally decreased VAS scores (MD=-1.10, 95% CI -1.14 to -1.06, P< 0.001) when used as an adjunct to conventional medicine. However, the safety of WNA was not specifically reported. Conclusions WNA may have beneficial effects on BMD and VAS scores of patients with primary OP. However, all included trials were at high risk of bias and of low quality. Further rigorous studies are needed to determine the effectiveness of WNA for primary OP treatment.