Bisphosphonates are highly effective inhibitors of osteoclastic bone resorption. They can be divided into two groups with distinct mechanisms of action. The nitrogen-containing bisphosphonates (pamidronate, alendronate, risedronate, incadronate etc) can inhibit the mevalonate pathway in osteoclasts and inhibit protein prenylation of small G proteins including Rho, which might lead to alter cytoskeletal organization and cell motility. Others, like etidronate and clodronate, do not inhibit protein prenylation and can be incorporated into ATP-containing compounds that may be cytotoxic to osteoclasts. Further studies would be required to elucidate the molecular mechanism of bisphosphonate actions.