The use of bisphosphonates in joint arthroplasty is the latest field of application for these agents. The mechanism of action of bisphosphonates suggests that they may optimize long-term survival of the implant. Most important is their potency in suppressing periprosthetic osteolysis due to the inflammatory foreign body reaction of wear debris, to decrease periprosthetic osteopenia caused by stress-shielding and to improve the osseointegration of cementless metal implants. The present review provides the latest information on definite and presumed mechanisms of action of bisphosphonates and their clinical importance.