An estimated 166,400 new cases of cancer will occur in Canada in 2008. Bone metastases unfortunately remain a common site of recurrence, with breast and prostate cancer patients representing a substantial proportion of this population. Metastatic bone disease is associated with significant morbidity and mortality. Pain is experienced by up to two thirds of patients. The prognosis for patients with bone metastases is highly influenced by tumor type, performance status, and the presence of extraosseous disease. The median survival has been significantly longer in breast cancer patients with a first relapse in the axial skeleton (24 months) versus patients with initial relapse in the liver (3 months) (2). Survival after diagnosis of bone metastases is influenced by the subsequent development of extraosseous metastatic sites: 1.6 years versus 2.1 years in patients with bone-only disease.