Accretion on to neutron stars (NSs) in X-ray pulsars (XRPs) results in intense X-ray emission, and under specific conditions, high-energy nuclear interactions that produce gamma-ray photons at discrete energies. These interactions are enabled by the high free-fall velocities of accreting nuclei near the NS surface and give rise to characteristic gamma-ray lines, notably at 2.2, 5.5, and 67.5 MeV. We investigate the production mechanisms of these lines and estimate the resulting gamma-ray luminosities, accounting for the suppression effects of radiative deceleration in bright XRPs and the creation of electron–positron pairs in strong magnetic fields. The resulting annihilation of these pairs leads to a secondary emission line at∼511 keV. We also discuss the possibility that non-stationary pair creation in the polar cap region could drive coherent radio emission, though its detectability in accreting systems remains uncertain. Using a numerical framework incorporating general relativistic light bending and magnetic absorption, we compute the escape fraction of photons and distinguish between actual and apparent gamma-ray luminosities. Our results identify the parameter space –defined by magnetic field strength, accretion luminosity, and NS compactness –where these gamma-ray signatures may be observable by upcoming MeV gamma-ray missions. In particular, we highlight the diagnostic potential of detecting gravitationally redshifted gamma-ray lines and annihilation features for probing the mass–radius relation and magnetospheric structure of NSs.