There are certain carcinomas that have a predilection for metastasis to bone. These include Breast, Lung, Thyroid, Prostate, and Renal carcinoma. However there are other lesions that can cause bone lesions (including Multiple Myeloma, Lymphoma). There are many factors that need to be evaluated for a patient with metastatic disease to bone, including the number of metastatic sites, the impending risk for fracture of the bone, medical stability for surgical intervention. Most importantly, it is imperative to gain an understanding of the patient’s goals in order to develop a comprehensive treatment plan that aligns with their goals.