A systematic review and exploratory meta-analysis of observational studies were conducted to provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin. A systematic review and exploratory meta-analysis of observational studies were performed. They conducted electronic searches of MEDLINE and Embase and a manual search of bibliographies for studies published to 28 March 2018. A total of 12 studies included in the meta-analysis. While the advantages of decreased fracture risk and higher BMD from aspirin use may be modest for individuals, whether established in prospective controlled trials, they may give a large population benefit given the common use of aspirin in older people.