Many patients with solid tumors, especially breast and prostate cancers, and with multiple myeloma will develop bone metastases or other skeletal complications. The management of bone loss and symptomatic bone metastases is an important issue in the care and maintenance of quality of life for these patients. Morbidity caused by skeletal complications include pain (bone metastases are known as the most common cause of cancer-related pain), hypercalcemia, pathologic fracture, compression of the spinal cord or cauda equine, and spinal instability. Currently, the only Food and Drug Administration-approved therapy for metastatic bone disease is bisphosphonate therapy. A greater understanding of the biomolecular pathways that govern the bone continuum of cancer has helped identify novel targets for drug development. New therapeutic options are currently being investigated for the treatments of bone loss and symptomatic bone metastases. Some of these new drugs and modalities are in advanced stages of clinical development and may soon reach the clinic.