Summary Plasma osteocalcin, a marker of osteoblastic activity, decreases after major abdominal and gynaecological surgery. Increased cortisol secretion and other hormonal and inflammatory components of the peri‐operative stress response may play a role in mediating this response. We␣assessed the effects of three different anaesthetic techniques on peri‐operative osteocalcin concentrations. Thirty‐six female patients undergoing elective total hip replacement were randomly assigned to receive propofol, propofol plus ‘three‐in‐one’ block or etomidate as part of a general anaesthetic technique. We measured plasma osteocalcin and serum cortisol, bone specific alkaline phosphatase, interleukin‐6, plasma epinephrine, norepinephrine, plasma glucose and cystatin C concentrations for up to 3 days after surgery. Etomidate successfully inhibited the cortisol response to surgery but plasma osteocalcin declined in all patients. This was accompanied by increased plasma catecholamines, interleukin‐6 and glucose concentrations, and decreased cystatin C‐values. Inhibition of the cortisol response to surgery failed to prevent a decrease in plasma osteocalcin concentrations after surgery, suggesting that other factors such as cytokines or catecholamines may play a significant role.