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Abstract Background Fragility fractures are a major public health concern among older adults in Japan. In 2024, the U.S. Preventive Services Task Force (USPSTF) released a draft update of its evidence review on screening for osteoporosis. We conducted a systematic review, commissioned by the Japan Preventive Services Task Force (JPPSTF), to update and apply the USPSTF draft by incorporating Japanese-language literature and additional recent international evidence. Methods This review followed the USPSTF analytic framework. We evaluated evidence on the effectiveness of screening; the predictive and diagnostic accuracy of clinical risk assessment tools; the predictive accuracy of bone mineral density (BMD) testing; the potential harms of screening; and the benefits and harms of pharmacologic treatments approved in Japan. Literature searches were conducted by the International Medical Information Center (IMIC). PubMed and the Cochrane Library were searched for studies published from November 11, 2022, to November 26 2024, and Ichushi-Web (Japan Medical Abstracts Society) was searched without publication date restriction. Searches were limited to English and Japanese. Study selection, data extraction, and risk of bias assessment were conducted independently by two or more reviewers for each key question, and disagreements were resolved through discussion.Findings from newly identified studies were qualitatively synthesized alongside the USPSTF review. Results Osteoporosis screening was generally associated with a modest reduction in hip and major osteoporotic fractures among postmenopausal women, particularly those aged 65 years or older. Risk assessment tools showed moderate predictive accuracy; diagnostic accuracy varied. Harms of screening were infrequently reported. Pharmacologic treatments approved in Japan were associated with fracture risk reduction, with no consistent evidence of serious harms. These findings were broadly consistent with those of the USPSTF review. Conclusions This systematic review provides an updated and objective evaluation of the internal validity of current evidence on osteoporosis screening and treatment in primary care settings in Japan.