Bone metastases are associated with significant skeletal-related morbidity that negatively correlates with quality of life and survival in patients with prostate cancer. Once prostate cancer has metastasized to bone, the median survival of patients is approximately 30 to 53 months; therefore, the chronic consequences of bone complications must be taken into consideration when developing long-term therapeutic strategies in this patient population. In addition to the bone-damaging effects of metastases, bone loss related to long-term hormonal therapy, as well as age-related bone loss, further compromise bone integrity in patients with advanced prostate cancer. This article reviews the burden of skeletal complications in patients with prostate cancer, and the evidence for the use of bisphosphonates for the treatment of skeletal morbidity in this patient population.