12 randomized controlled trials were included in this meta-analysis which sought to evaluate the effect of bisphosphonate therapy in reducing loss of periprosthetic bone mineral density after total hip arthroplasty. In pooled analyses, reduction of periprosthetic bone mineral density was smaller among BP groups compared to control groups within 1 year of surgery, at 2-4 years after surgery, and at 5 or more years after surgery. However, the effect was largely impacted by the efficacy of third generative BPs. In subgroup analysis, third generation BPs demonstrated a significant effect versus control at each of 1 year, 2-4 years, and 5 or more years after surgery, whereas first and second generation BPs demonstrated a significant effect versus control groups at only 1 year after surgery.