Multiple osteoarticular tuberculosis (MOT) represents an uncommon yet severe form of tuberculosis, characterized by a lack of systematic analysis and comprehension. Our objective was to delineate MOT’s epidemiological characteristics and establish a scientific foundation for prevention and treatment. We conducted searches across eight databases to identify relevant articles. Pearson’s chi-square test (Fisher’s exact test) and Bonferroni method were employed to assess osteoarticular involvement among patients of varying age and gender (α = 0.05). The study comprised 98 articles, encompassing 151 cases from 22 countries, with China and India collectively contributing 67.55% of cases. MOT predominantly affected individuals aged 0–30 years (58.94%). Pulmonary tuberculosis was evident in 16.55% of cases, with spinal involvement prevalent (57.62%). Significant differences were noted in trunk, spine, thoracic, and lumbar vertebrae involvement, as well as type I lesions across age groups, increasing with age. Moreover, significant differences were observed in upper limb bone involvement and type II lesions across age groups, decreasing with age. Gender differences were not significant. MOT primarily manifests in China and India, predominantly among younger individuals, indicating age-related variations in osteoarticular involvement. Enhanced clinical awareness is crucial for accurate MOT diagnosis, mitigating missed diagnoses and misdiagnoses.