“…They act by promoting osteoclast apoptosis and inhibiting differentiation to mature osteoclasts [16,25,30,32,40,41] or by reducing osteoclast activity [2,10,11,15,31,38,40,44], either through an inhibition of farnesyl diphosphonate synthase (FPP) in the mevalonate pathway, or by otherwise inhibiting prenylation of small GTPases. The influence of bisphosphonates on bone formation is unknown, although it has been hypothesized, based primarily on studies in culture, that bisphosphonates inhibit osteoblast apoptosis [1,35,38] and may stimulate osteoblast proliferation and differentiation [18,19,23,26,41,42], leading to increased bone formation.…”