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OBJECTIVES: We aimed to systematically evaluate the impact of glucocorticoid (GC) exposure on trabecular bone score (TBS). METHODS: The protocol was registered on PROSPERO (No: CRD420250632403). PubMed/Medline, Embase, OVID, and the Cochrane Library databases were systematically searched until December 2024. Studies that assessed TBS and areal bone mineral density (aBMD) in both GC-treated patients and non-GC controls were included. We assessed risk of bias using the Joanna Briggs Institute Checklist. Data were analyzed using the random effects model. For heterogeneity, we performed subgroup and sensitivity analyses. RESULTS: A total of 8 studies involving 3215 participants were included. Compared to controls, GC-treated patients had significantly lower TBS (SMD = -0.47; 95%CI: [-0.64, -0.31], P < 0.00001) and lumbar spine (LS) aBMD (SMD = -0.1784; 95%CI: [-0.3190, -0.0378], P = 0.01), along with a borderline reduction in total hip aBMD (SMD = -0.2686; 95%CI: [-0.5353, -0.0019], P = 0.05). Femoral neck aBMD showed no significant difference (P = 0.06). Subgroup analyses revealed that TBS was significantly lower regardless of sex, ethnicity, and body mass index. While LS-aBMD showed significantly lower values in females (SMD = -0.25, 95%CI: [-0.39, -0.11], P = 0.0005) and White population (SMD = -0.20, 95%CI: [-0.38, -0.03], P = 0.03). After adjusting for disease-matched controls, confounders, and DXA manufacturer, TBS results remained robust, while aBMD outcomes showed greater variability. CONCLUSION: GC exposure is associated with significant and consistent deterioration in TBS across diverse subgroups. Combining TBS with aBMD is recommended for assessing the bone health in patients treated with GC.