In this issue of JAMA Internal Medicine, Greenspan and colleagues1 present intriguing data on zoledronic acid, one of the most potent drugs in the bisphosphonate family—if not the most potent—approved for treatment of osteoporosis. In a study of frail elderly women living in nursing homes, the authors suggest that a single 5-mg infusion of zoledronic acid, while producing the expected effects on surrogate outcomes (reducing bone remodeling and increasing bone mineral density [BMD]), failed to reduce the incidence of fractures over a 2-year period. The study deserves careful evaluation and interpretation before any modifications to clinical practice can be recommended.