BACKGROUND: In recent years, percutaneous kyphoplasty (PKP) has been widely used in the treatment of osteoporotic vertebral compression fractures, but there are still some complications, such as bone cement leakage and re-fractures, and a lack of follow-up treatment.OBJECTIVE: To investigate the effect of PKP with low-dose bone cement in combination with zoledronic acid on bone mineral density (BMD), vertebral height and low back pain after osteoporotic vertebral compression fractures.METHODS: Eighty patients with osteoporotic vertebral compression fractures were equally randomized into test group (treated with PKP with low-dose bone cement in combination with zoledronic acid) and control group (treated with PKP with conventional bone cement). Visual analog scale score, vertebral height, and Cobb angle were detected before, at 3 days after treatment and at the final follow-up visit. BMD and re-fracture incidence were reviewed 1 year after treatment.RESULTS AND CONCLUSION: Visual analog scale scores, vertebral height, and Cobb angle were significantly improved in both groups at 3 days after treatment and at the final follow-up visit (P < 0.05); however, there was no statistical difference between the test and control groups. One year after treatment, the BMD value was significantly increased in the test group (P < 0.05), but showed no change in the control group as compared with the pretreatment.Postoperatively adjacent vertebral fractures were found in one case of the test group, and five cases in five cases of the control group. These findings indicate that PKP with low-dose bone cement in combination of zoledronic acid can effectively relieve pain symptoms, restore the height of the vertebral body, significantly increase BMD value and reduce the incidence of adjacent vertebral fractures in patients with osteoporotic vertebral compression fractures.