Bladder cancer is the most common cancer among Egyptian males and the forth mostcommon among females . Distant metastases rate is 23% of which 23% are to bone .In this study 40 patients with metastatic bladder cancer to bone were randomized toreceive eithe placebo 250 cc of saline / 4 weeks for six months or 4 mg zoledronic acid / 4weeks for six months . Zoledronic acid had effectively decreased skeletal morbidity ratefrom 2.05 to 0.9 , prolonged mean time to first skeletal related events from 8 weeks to 16weeks and reduced pain score from 4.37 to 2.95 . The cumulative overall survival at oneyear was 5 % in placebo arm and 30 % in Bisphosphonates arm . No statisticallysignficant difference in the rate of complications was found between the two treatmentarms .Key words :Bladder cancer , distant metastases, bone metastases, Bisphosphonates,Skeletal related