238 patients with primary osteoporotic vertebral compression fractures were randomized to receive either percutaneous kyphoplasty with zoledronic acid (n=119) or percutaneous kyphoplasty alone (n=119). Outcomes of interest included pain on a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), bone mineral density (BMD), procollagen type I N-terminal propeptide (PINP) levels, osteocalcin in the N-terminal molecular fragement levels, B-C-terminal telopeptide of type I collagen (CTX) levels, vertebral body height, Cobb angle, and adverse events at 1 week, 3, 6, and 12 months. Pain at 12 months, ODI, BMD, bone marker levels, and vertebral body height at all time points, Cobb anlge at 12 months, and incidence of new vertebral compression fracture all favoured the percutaneous kyphoplasty with zoledronic acid group.