〔Abstract〕 Objective To analyze the application value of percutaneous vertebroplasty (PVP)/percutaneous kyphoplasty (PKP) combined with zoledronic acid in the treatment of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF). Methods A total of 62 patients with thoracolumbar OVCF admitted to the South Hospital of Fujian Provincial Hospital from May 2019 to May 2021 were selected and divided into an observation group and a control group by random number table method, with 31 cases in each group. The control group was treated with PVP/PKP, and the observation group was treated with zoledronic acid intravenous drip after operation on the basis of the control group. The Cobb angle and anterior vertebral height, the scores of visual analogue scale (VAS) and Oswestry dability index (ODI), serum bone alkaline phosphatase (BALP), C-telopeptide of type1 (CTX-1), vertebral bone mineral density (BMD) of the two groups were compared before and after operation 3 months and 6 months, and refracture rate were measured at 1 year after treatment. Results The Cobb angles of the observation group at 3 months and 6 months after operation were lower than those of the control group, and the anterior height of the injured vertebra was higher than that of the control group, and the differences were statistically significant (P < 0.05). The scores of VAS and ODI of the two groups at 3 months and 6 months after operation were lower than those before operation, the scores of the observation group were lower than those of the control group, and the differences were statistically significant (P < 0.05). The levels of BALP and CTX-1 of the observation group at 3 and 6 months after operation were lower than those of the control group, and the BMD was higher than that of the control group, and the differences were statistically significant (P < 0.05). Conclusion PVP/PKP combined with zoledronic acid in the treatment of OVCF can relieve postoperative pain, improve vertebral function, regulate bone metabolism, increase bone mineral density and reduce the occurrence of refracture.