Background <p>Although prior studies alluded to the association between inflammatory bowel disease (IBD) and osteoporosis, the exact prevalence of osteoporosis in this patient population remains variably reported. Therefore, we aimed to systematically explore the overall prevalence of osteoporosis in patients with IBD.</p> Methods <p>We searched in Embase, PubMed, and Scopus, from the inception until 31 May 2024. We included studies that reported cross-sectional data on the prevalence of osteoporosis in at least 100 adult (≥ 18 years) patients with IBD. We combined the data extracted from the eligible studies to obtain pooled estimates using a random-effects model.</p> Results <p>A total of 24 articles were included, comprising 417,298 patients with IBD. Our analysis showed that the overall pooled prevalence of osteoporosis in IBD patients was 12.2% (95% confidence interval [CI]: 9.1–15.3; I² = 99.7%), with varying rates by country. We also found that the osteoporosis risk in patients with IBD increased versus controls (pooled odds ratio = 1.64, 95% CI: 1.24–2.16). There were no significant differences in the prevalence of osteoporosis by disease type (Crohn’s disease, 14.9% [95% CI: 8.8–20.9]; ulcerative colitis, 11.4% [95% CI: 5.8–17.0]; p for interaction = 0.408) and sex (men, 9.6% [95% CI: 3.0-16.3]; women, 10.5% [95% CI: 6.8–14.1]; p for interaction = 0.832).</p> Conclusion <p>There is a significant prevalence of osteoporosis in patients with IBD, though variations by disease type and sex are not probably observed. We witnessed high heterogeneity among the studies. Tailored approaches are warranted for osteoporosis screening and management in this patient population.</p>