Metastatic bone disease causes significant pain and disability in cancer patients. In the United States, approximately 500,000 new cases of bone metastases are diagnosed annually. Metastatic bone disease is most commonly due to carcinomas of the breast, prostate, kidney, and lung. Multiple myeloma is the most common cause of primary bone tumors in adults. Metastatic bone disease can occur in any bone but most commonly affects the spine, pelvis, ribs, and long bones, particularly the femur and humerus. Clinical management of metastatic bone disease is complex and should involve multidisciplinary care. Pain is the most common skeletal-related event in metastatic bone disease and treatments available for pain management include analgesic medication, radiation therapy, systemic therapies, and surgery. Pathologic fractures of long bones should be stabilized with surgery to improve pain, increase mobility, and allow patients to continue tolerating systemic treatments. A combination of treatment options is often best at minimizing pain in metastatic bone disease and maximizing quality of life.