Skeletal bone metastases are a common complication of advanced lung cancer, significantly impacting patients’ quality of life and clinical outcomes. Approximately 30–40% of patients with lung cancer develop bone metastases, with skeletal involvement often signaling an advanced stage of the disease. The management of these metastases involves a multidisciplinary approach focused on alleviating pain, preventing skeletal-related events (SREs), and improving functional status and overall survival. Prognosis varies and depends on stage at presentation, the presence of driver mutations, and the amount of PD-L1 expressed by tumor cells.