The role of metal ions in the body and particularly in the formation, regulation and maintenance of bone is only just starting to be unravelled. The role of some ions, such as zinc, is more clearly understood due to its central importance in proteins. However, a whole spectrum of other ions is known to affect bone formation but the exact mechanism is unclear as the effects can be complex, multifactorial and also subtle. Furthermore, a significant number of studies utilise single doses in cell culture medium, whereas the continual, sustained release of an ion may initiate and mediate a completely different response. We have reviewed the role of the most significant ions that are known to play a role in bone formation, namely calcium, zinc, strontium, magnesium, boron, titanium and also phosphate anions as well as copper and its role in angiogenesis, an important process interlinked with osteogenesis. This review will also examine how delivery systems may offer an alternative way of providing sustained release of these ions which may effect and potentiate a more appropriate and rapid tissue response.