Bony fibrous dysplasia is one of the hallmark features of McCune-Albright syndrome. Fibrous dysplasia can result in pain, fracture and deformity in affected areas. A number of observational, uncontrolled reports have been published outlining results of bisphosphonate therapy for fibrous dysplasia. Bisphosphonates are well tolerated and appear to be useful for reducing bone pain. Although their use is also associated with decreases in bone turnover, increases in bone density and radiological changes, their impact on the overall course of the disease, particularly the incidence of fractures and deformity, is less clear. Many questions remain about optimizing their use for fibrous dysplasia therapy.