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We performed this retrospective clinical study to examine the prognostic power of bone scintigraphy (BS) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in terms of overall survival (OS) of breast cancer with bone-only metastasis.We retrospectively evaluated 100 female invasive ductal breast cancer patients (mean age 48.1 years) with bone-only metastasis. Twenty-five patients had human epidermal growth factor receptor 2 (HER2)-positive tumors, 65 were estrogen receptor (ER) and/or progesterone receptor (PR)-positive, HER2-negative tumors, and 10 were triple negative tumors. The patients were treated properly with various treatments, including chemotherapy, radiotherapy, hormone, and bisphosphonate therapy, based on their clinical status. All patients underwent BS and FDG PET/CT at baseline and 1 year after treatment. The baseline and follow images were visually compared, and the patients were grouped as responders or nonresponders based on their images. OS was compared between the groups.The mean OS after the diagnosis of bone-only metastasis was 57.6 months. Fifty-one patients (51%) died within 5 years after diagnosis of metastasis. No difference in survival was evident between responders and nonresponders based on BS imaging data (P = .090). The response status based on PET imaging data waste only significant independent prognostic factor on multivariate analysis (P = .001). Survival was lower in nonresponders than in responders based on PET imaging (32.7% vs 66.4%; P < .001).Our findings suggest that the response status according to FDG PET imaging can be used to predict OS in breast cancer patients with bone-only metastasis.