Four RCTs were included in the review (n=103 patients). The sample size of included trials ranged from 12 to 29 patients. The length of follow-up ranged from nine to 12 months. There was no evidence of publication bias
Bone mineral density: There was a statistically significant improvement in femur neck bone mineral density with zoledronate at follow-up compared with baseline (SMD 0.41, 95% CI 0.09 to 0.74; three trials; I2=0%). There was also a statistically significant improvement in lumbar spine bone mineral density with zoledronate at follow-up compared with baseline (SMD 0.91, 95% CI 0.61 to 1.20; four trials; I2=77%). In both the femur neck and the lumbar spine there was a statistically significant improvement in bone mineral density with zoledronate at follow-up compared with baseline (SMD 0.69, 95% CI 0.47 to 0.90; four trials; I2=67%). There was no statistical difference in zoledronate at follow-up in the other body sites; the authors did not show these results. Subgroup analysis revealed that when zoledronate was given every three months, the benefit in terms of bone mineral density was sustained (SMD 0.74, 95% CI 0.50 to 0.97; four trials).
Markers of bone turnover: The authors reported that zoledronate decreased markers of bone resorption, bone formation, and other markers. Markers of osteoclast function were inconclusive.
Pain: Two trials reported a reduction in pain with zoledronate at follow-up compared with baseline.
Adverse events: There were no reports of atrial fibrillation in any of the trials. One trial reported an acute cardiac death.