The necessity of lifelong treatment and the potential side effects like upper gastrointestinal symptoms hinder pharmacologic treatments for osteoporosis. Tai Chi (TC), one of traditional Chinese exercises without side effects, has proven to be effective in the treatment of many orthopedic diseases. This systematic review was performed to determine the clinical efficacy and safety of TC for osteopenia and primary osteoporosis and provide clear evidence to inform clinical practice. Results: Meta-analysis showed that there was no statistically difference between TC plus conventional treatments (CTs) and CTs on any outcomes. Both in the subgroup that TC versus no intervention and TC versus CTs, there was significant difference on spinal bone mineral density (BMD; 95% confidence interval [CI]: 0.60 to 1.02; 95% CI: 0.09 to 0.23) values, femoral BMD value (95% CI: 0.01 to 0.06; 95% CI: 0.04 to 0.29). Two trials compared TC versus no treatment through the index of quantitative ultrasound but result indicated that TC maybe have a little bit effect only on reducing the SOS (95% CI: 1.28 to 25.76). In addition, 2 trials compared TC plus CTs versus CTs on BGP (95% CI: -1.66 to -0.70), which found a remarkable difference between the 2 groups. Conclusions: There were positive results for TC to benefit for osteopenia and primary osteoporosis. However, the relevant evidence should be interpreted with caution due to the low methodological quality. International methodological and reporting standards could help researchers conduct well-designed trials and improve the level of evidence for Chinese herbal medicine.