Bisphosphonates (BPs) provide meaningful clinical benefit in cancer patients by significantly reducing the onset of skeletal complications. Apart from their established role in the treatment of hypercalcaemia of malignancy and bone metastases, these agents have also been explored in earlier stages of disease. In particular, BPs have shown the promise of a role in the adjuvant setting, to prevent bone metastatisation, and to prevent loss in bone density related to cancer therapies. This review will briefly summarise the current evidence in these particular settings, and will examine new potential approaches to metastatic bone disease, including new agents, new formulations and new schedules for BPs. Most available data are focused on breast cancer and prostate cancer; this is because of: their prevalence worldwide, the likelihood of bone metastatisation caused by these diseases, and the loss in bone density being a major clinical concern in these patients as a consequence of both aging and cancer therapies.