There is emerging evidence of a possible association between migraine and bone health, particularly osteoporosis, yet this remains underexplored. The objective of this study was to evaluate the association between migraine and bone health and whether migraine increases osteoporosis risk, through a systematic review and meta-analysis; and to explore possible shared biological mechanisms. A systematic search of MEDLINE, Embase, and Cochrane CENTRAL databases was conducted up to 11 June 2025. Eligible studies included observational studies assessing migraine and bone health in adults. Risk of bias was assessed using the Joanna Briggs Institute tools. Meta-analysis was performed on studies reporting odds ratios (ORs) for osteoporosis in migraine, using a random-effects model. Heterogeneity and publication bias were evaluated. Additional studies addressing other bone health markers were narratively reviewed. Out of 5,411 studies initially identified, six met inclusion criteria. Three reported the odds of osteoporosis in patients with migraine and were included in the meta-analysis. The pooled OR for osteoporosis in individuals with migraine was 1.86 (95% CI: 1.78–1.94; p < 0.0001) with no significant heterogeneity. Three additional studies examined surrogate bone markers or osteoporosis as a migraine risk factor, reporting findings consistent with an association. Potential mechanistic links included CGRP signaling, inflammation, magnesium metabolism, and shared risk factors such as physical inactivity and vitamin D deficiency. In conclusions, this systematic review and meta-analysis suggest an association between migraine and osteoporosis; that migraine increases the risk of osteoporosis and that this relationship may be bidirectional.