AbstractDiffuse sclerosing osteomyelitis (DSO) is a rare inflammatory disease of bone. The underlying cause is poorly understood and traditional management techniques have struggled to provide patients with adequate relief. A number of reports in the literature have described the use of bisphosphonates to manage DSO; however, these have predominantly been associated with the intravenous formulation. Understandably, there is an element of angst due to its underlying and well‐recognised risk of osteonecrosis of the jaw. In this article, we review the literature for the management of DSO including the novel approach of using bisphosphonates. As an example, we present a case of a 56‐year‐old female with DSO where conventional therapies failed to manage her symptoms; however, treatment with oral alendronic acid led to complete and sustained resolution. This case in conjunction with additional reported cases provides further evidence of the value of bisphosphonates in DSO and highlights that the use of oral bisphosphonates can be successful and could be a viable consideration prior to the use of intravenous versions.