There is a paradox surrounding the use of bisphosphonates and bone biology. On one hand, it has been used to treat osteoporosis, osteogenesis imperfecta, Pagets disease, osteonecrosis, and other disorders associated with low bone mass. On the other hand, there have been a number of cases reported suggesting an association between treatment with bisphosphonates and osteonecrosis of the jaw. Answers to why this paradox exists lies in a better understanding of the pathogenesis of osteonecrosis and the mechanism of action of bisphosphonates. This seminar was created to explore the perspectives of three different medical disciplines concerning the use of bisphosphonates.