48 patients with painful bone marrow lesions were randomized to receive Vitamin D and calcium supplementation plus a single dose of intravenous Zoledronic acid (n=34) or placebo (n=14). The primary outcome of interest was the change in volume/size of the lesion. Secondary outcomes of interest included pain on a Visual Analog Scale (VAS), pain disability index (PDI), bone-specific quality of life questionnaire (Qualeffo-41), and adverse events. Results revealed a significantly greater reduction in lesion volume with zoledronic acid, demonstrating a mean reduction of 64.53% vs. an increase in lesion size of 14.43% in the placebo group. VAS pain scores were significantly in favour of the Zoledronic acid group between 6 and 12 weeks follow up. 31 patients reported 83 adverse drug reactions in the Zoledronic acid group, vs. 6 patients and 13 adverse drug reactions in the placebo group.