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Background: Aquatic exercises have been widely used to treat people with osteopenia and osteoporosis (OP), claiming that they may improve balance; nonetheless, there is still controversy on its use for this population. Objectives: To investigate the effects of aquatic exercise (AE) on people with osteopenia or OP. Methods: Systematic review that included clinical trials, with at least one AE group and a control group. The electronic databases PubMed, EMBASE, Cochrane, Scopus and Web of Science were searched. The risk of bias assessment was performed independently by two reviewers with the Revised Cochrane risk‐of‐bias tool for randomized trials (RoB 2). Results: A total of 1793 articles were identified, and 7 articles were considered eligible, mostly considered as of low risk of bias. The total sample size was composed of 562 women (mean ages between 58.6 ± 6.7 and 73.3 ± 3.9). The interventions were supplementation, pharmacological treatment and protocols both of land‐based exercises (LE) and AE. Outcomes were quality of life, functionality, balance, function, mobility, handgrip, lower limbs and trunk strength, flexibility and pain, with controversial results on all variables. Conclusions: Even though AE seem to be beneficial for people with osteopenia or OP, protocols for evaluation and treatment are heterogeneous and did not allow a meta‐analysis computation. As such, it was not possible to conclude if AE are beneficial to people with osteopenia or OP. Trial Registration: This systematic review was registered in the international prospective register of systematic reviews (PROSPERO [OMITTED FOR BLINDING PURPOSES]). [ABSTRACT FROM AUTHOR]