Objective:To evaluate the efficacy of exercise therapy combined with drug therapy for the treatment of patients with primary osteoporosis based on randomized controlled trial by meta-ananlysis.Methods:Randomized controlled trials of exercise therapy combined with drugs in the treatment of primary osteoporosis published between Jan 1,2000 to Apr 30,2024 in PubMed,EMbase,Cochrane Library,CNKI,VIP were researched.The search strategy combining Medical Subject Headings and free words.After literature screening,quality evaluation and data extraction,meta-analysis was used for quantitative analysis and evaluation.Q test and I2 test were used for heterogeneity test.Subgroup analysis was performed according to the type of drug intervention.Sensitivity analysis was used to evaluate the stability of results,and funnel plot was used to evaluate potential publication bias.Results:A total of 28 literatures were included in this study,including exercise therapy combined with drug therapy group(1 140 cases)and drug therapy alone group(1 136 cases).The results showed that compared with drug therapy alone,exercise therapy combined with drug therapy had statistically significant differences in bone mineral density(BMD)of lumbar vertebra(SMD=1.42,95%CI:1.11-1.73),femur(SMD=1.14,95%CI:0.73-1.56)and hip(SMD=0.59,95%CI:0.09-1.09)(P＜0.05).Exercise therapy combined with drug therapy was also superior in alleviating pain in patients(SMD=-1.94,95%CI:-2.50--1.38,P＜0.05).The results of total subgroup analysis showed statistically significant differences among different drug interventions(P＜0.05).Conclusions:Exercise therapy combined with drug therapy has a good intervention effect on primary osteoporosis.However,due to the small sample size of the included studies,the results still need to be further verified by large sample population studies.