Eight randomized controlled trials including 578 patients with osteoporotic vertebral compression fracture who underwent percutaneous kyphoplasty were randomized to undergo zoledronic acid injections (n=285) or no treatment (n=293). Primary outcomes included bone mineral density (BMD), pain on the visual analogue scale (VAS), disability using the Oswestry Disability Index (ODI), incidence of recompression vertebral fracture. Secondary outcomes included bone metabolism markers. Pooled results revealed that BMD and VAS pain at 6 months and 12 months follow-up significantly favored the zoledronic acid group vs control (p<0.05 for all). Moreover, pooled ODI scores at 12 months follow-up and incidence of recompression vertebral fracture scores were significantly reduced in the zoledronic acid group vs control (p<0.0001 for both).