Objective To discuss the curative effect of zoledronic acid on severe osteoporosis in the elderly. Methods Totally 120 patients were randomly divided into treatment group(n=60, mean age: 67.6 years) receiving Caltrate D and Alpha D3 plus zoledronic acid treatment for 24 weeks, and the control group(n=60, mean age: 66.4 years) receiving Caltrate D and Alpha D3 treatment only. Bone pain of patients in two groups before and two weeks after treatment was assessed and bone mineral density(BMD) of hip and lumbar vertebrae was examined before and 12 months after treatment. In addition, calcium, phosphorus and alkaline phosphatase(AKP) in plasma were also assessed and adverse events were observed. Results After excluding the 3 drop-out cases, bone pain was alleviated faster in treatment group(n=57) than in control group(n=53), and improvement of BMD in treatment group was also significantly better than that in control group(P＜0.05). AKP was decreased significantly in treatment group[(95.2±11.2) vs (147.3±16.1)IU/L; P＜0.05], while kept no change in control group after treatment. There were no significant differences in the levels of plasma calcium and phosphorus in both groups between pre- and post- treatment(P＞0.05). Conclusion Zoledronic acid can significantly relieve pain and other symptoms, and improve BMD in patients with severe osteoporosis.