With the aging of the population, the prevalence of age-related diseases is increasing worldwide, particularly degenerative spinal disorders. Degenerative disc disease of the lumbar spine in the elderly is a global health issue, particularly in patients with osteoporosis. Osteoporosis is a common metabolic bone disease that occurs frequently in elderly individuals.1 Osteoporosis in the elderly can contribute to the failure of internal fixation.2 Patients with osteoporosis may experience complications such as vertebral pedicle fractures, screw loosening, pseudarthrosis, adjacent vertebral fractures, proximal junctional kyphosis, and implant failure with screw loosening rates exceeding 22%.3 Poor bone quality can complicate spinal fusion surgery as it relies on strong bone quality for successful fusion. Spinal fusion surgery requires a robust bone structure to ensure effective fusion.4 Managing osteoporosis in spinal surgery patients is highly challenging, but with appropriate patient selection, medical optimization, and surgical techniques, patients can experience pain relief, deformity correction, and improved functionality.5 Optimizing the outcomes of spinal surgery in osteoporosis patients is possible through thorough preoperative evaluations, medical management, and adjustments in surgical techniques. This is particularly crucial when performing complex spinal instrumentation.1,6 Therefore, the intervention for osteoporosis treatment will be a key factor in the success of spinal fusion surgery. Currently, it is known that preoperative medication can be effective in the treatment of osteoporosis. Pretreatment with medications to prevent bone loss prior to surgery was associated with lower pseudarthrosis and revision surgery rates, although the differences did not reach statistical significance.7 There are various medications available for the treatment of osteoporosis. Teriparatide (TP) is a safe and effective anabolic treatment for osteoporosis.8 Which is the main treatment approaches for osteoporosis in recent years. TP acts on the parathyroid hormone receptor 1 and is administered through daily subcutaneous injections for a maximum duration of 2 years.9 In recent years, several meta-analyses have shown a close association between osteoporosis medication treatment and spinal fusion surgery.10, 11, 12 This study aims to further investigate the therapeutic effects of TP in this context. As such, the goal of this systematic review and meta-analysis was to compare the radiographic and functional outcomes of patients that had spine fusion with and without TP.