ObjectiveTo systematically analyze the studies investigating the outcomes of once-yearly administered intravenous zoledronic acid for preventing postmenopausal osteoporosis fracture. MethodsCochrane’s systematic review methods were used to retrieve the randomized controlled trials (RCT) about decreasing the risks of osteoporosis fracture in postmenopausal women by zoledronic acid from Cochrane Library, PubMed(Jan. 1966 to Apr. 2011), OVID(Jan. 1993 to Apr. 2011), EMBASE(Jan. 1974 to Apr. 2011), CNKI (Jan. 1979 to Apr. 2011), and VIP (Jan. 1989 to Apr. 2011) database. The studies were limited to human studies including bone fracture rates and follow-up for 2-3 years. All literatures identified from the data sources were evaluated for review inclusion, and the methodology of the included literatures was evaluated. Meta-analysis was performed using RevMan 5.0.25 software. ResultsThree randomized controlled studies met the inclusion criteria, including a total of 11 947 postmenopausal women with osteoporosis. Meta analysis results showed that zoledronic acid could reduce clinical vertebral fractures, hip fractures and nonvertebral-nonhip fractures by 75% (RR=0.25, 95%CI: 0.18-0.36), 33% (RR=0.67, 95%CI: 0.52-0.85), and 24% (RR=0.76, 95%CI: 0.67-0.87), respectively (P<0.05 for all comparisons). The incidence rates of serious adverse events were not significantly different between zoledronic acid group and placebo group. ConclusionOnce-yearly intravenous injection of zoledronic acid (5 mg) can effectively prevent osteoporosis fracture in postmenopausal women without increasing the risk of serious adverse events.