Many bivalve species occur in aggregations, and locally cover large parts of the seafloor. Above a certain density they provide a distinct, three-dimensional structure and the aggregations are called bivalve beds or reefs. These persistent aggregations form a biogenic habitat for many other species. Bivalve beds, therefore, often have, in comparison with the surrounding areas, a high biodiversity value and can be seen as hotspots for biodiversity. Bivalve have a wide global distribution, on rocky and sedimentary coasts. Different processes and mechanisms influence the presence of associated benthic fauna. This paper reviewed the main drivers that influence the biodiversity, such as the bivalve species involved, the density, the size and the age of the bed, the depth or height in the tidal zone and the substratum type. Bivalve beds not only occur naturally in many subtidal and intertidal areas around the world, but mussels and oysters are also extensively cultured. Addition of physical cultivation structures in the water column or on the bottom allows for development of substantial and diverse communities that have a structure similar to that of natural beds. Dynamics of culture populations may however differ from natural bivalve reefs as a result of culture site and/or maintenance and operation like harvesting of the bivalve cultures. We used the outcome of the review on the drivers for wild assemblages to evaluate trade-offs between bivalve aquaculture and biodiversity conservation. Studies comparing natural and cultured assemblages proved to allow for a better understanding of the effect of the culture strategies and, consequently, to forward sustainable bivalve cultures. This is illustrated by a case study in the Dutch Wadden Sea.