Five studies including 534 patients with rotator cuff tears were included in this systematic review and meta-analysis comparing postoperative use of anti-osteoporosis drugs vs. no drug use following arthroscopic rotator cuff repair. Pooled outcomes of interest included retear rate, shoulder-specific functional scores (ASES, UCLA, CSS, SST), and shoulder range of motion (forward flexion and internal rotation). The meta-analysis found a significantly lower retear rate and higher ASES scores in the anti-osteoporosis group, along with improved internal rotation angle. There were no significant differences in forward flexion or other shoulder scores. The findings suggest that anti-osteoporosis therapy enhances tendon-to-bone healing and shoulder function, particularly for movements involving internal rotation.