Patients with advanced cancer and bone metastases frequently experience debilitating skeletal complications that can substantially affect their quality of life. Complications of tumour bone disease include severe and incapacitating pain, pathological fractures, spinal cord compression and hypercalcaemia. Many types of cancer metastasize to the bone, but breast and prostate cancer account for roughly 70-80% of bone metastases. The treatment of metastatic disease requires a multidisciplinary approach that addresses systemic and local disease. Where the treatment objective is pain relief, a single 8 Gy treatment is recommended as the standard dose-fractionation treatment of symptomatic and uncomplicated bone metastases. External beam irradiation achieves pain palliation in more than 75% of patients. Radiotherapy with doses of 40-50 Gy resulted in remineralization in 60-80% of the patients 4-8 weeks after irradiation. Bisphosphonates have emerged as a leading therapeutic intervention for the treatment and prevention of skeletal complications of malignancy. They have been shown to be highly effective in the treatment of osteolytic, mixed and osteoblastic bone metastases in patients with breast cancer and prostate cancer.