This meta-analysis included 22 randomized controlled trials with a total of 11,852 patients diagnosed with osteoporosis, comparing zoledronic acid treatment to placebo. Pooled outcomes of interest included changes in BMD (lumbar spine, femoral neck, and trochanter), bone turnover markers (CTX, BSAP, and P1NP), serum sclerostin levels, Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), adverse events, and fracture incidence. Results demonstrated that zoledronic acid significantly increased BMD, reduced bone turnover markers, lowered VAS and ODI scores, and decreased the incidence of fractures. However, treatment with zoledronic acid was associated with a higher incidence of adverse events compared to placebo. These findings suggest that zoledronic acid is an effective treatment for osteoporosis, improving bone health and reducing fractures, but it carries a risk of increased side effects.