The evaluation of patients with suspected bone metastases should be done in an efficient and cost-effective manner. The surgeon must assess the risk for fracture in order to recommend prophylactic fixation when necessary. Surgical treatment must be rigid and durable to allow early function. The majority of lesions need adjunctive external beam irradiation following surgery. Innovative research on tumor markers is currently underway in many centers. Sophisticated radiographic studies will allow clinicians to assess response to treatment. The diphosphonate class of medications has shown early encouraging results in the systemic treatment of bone metastases. A newer generation of diphosphonates has improved efficacy and has reduced side effects.