The driver was also killed in what Israeli police were calling an attack at the location overlooking holy sites in the Old City such as the Dome of the Rock and providing one of the most spectacular views of Jerusalem.
Chaos broke out at the scene when the truck ploughed through the crowd, with hundreds of soldiers having arrived there as part of a tour for troops about the history of Jerusalem.
"They got off the bus, and as they were getting off the bus and getting organised, he took advantage."
Police spokeswoman Luba Samri said the driver was killed by Israeli forces, without specifying whether it was soldiers or police.
Multiple bullet holes could be seen in the windshield of the truck.
Police only confirmed four people were dead, but a medic at the scene said they were soldiers.
Video said to be of the incident being shared online showed a flatbed truck with a crane in the rear drive through a group of soldiers standing next to a bus.
Ambulances rushed to the location and video showed visitors, including soldiers, running for cover as the incident began. Bodies were later covered in sheets.
"I heard my soldiers screaming and shouting," said one of the tour guides, Lea Schreiber.
"I saw a truck that went on the side of the road. Soldiers starting shooting... There were orders and screaming everywhere. They told them to hide behind the wall because there was fear of another attack."
Palestinian security officials in the West Bank city of Ramallah said the driver was a Palestinian in his late 20s from the east Jerusalem neighbourhood of Jabal Mukaber, located close to the scene.
Rosenfeld said it was not yet clear if the attack had been planned earlier or was spontaneous.
A wave of Palestinian knife, gun and car-ramming attacks broke out in October 2015, but the violence had greatly subsided in recent months.
Since October 2015, 247 Palestinians, 40 Israelis, two Americans, a Jordanian, an Eritrean and a Sudanese have been killed in a wave of violence, according to an AFP count.
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