Fibrous dysplasia covers a variety of rather different clinical pictures. Its therapy therefore has to be individually adapted. In addition to the orthopaedic surgeon, endocrinologists and craniofacial surgeons are also involved in the process. In the present contribution the role of modern bisphosphonates as a conservative treatment strategy is discussed with regard to the prevalent therapeutic possibilities. The literature as well as personal experience show them to be an especially valid option for the treatment of polyostotic fibrous dysplasia and the various syndromes.