Bone metastases require a multidisciplinary treatment approach to provide optimal care for affected patients. Once metastasized to bone, cancer cells disturb the balance of bone formation and resorption, resulting in either predominantly osteolytic or sclerotic bone lesions. While the complex underlying pathophysiology of bone and cancer interactions is increasingly understood, pharmacological treatment approaches are currently limited to antiresorptive strategies. Antiresorptive treatment with bisphosphonates or the receptor activator of nuclear factor kappa-B ligand (RANKL) antibody denosumab has proven efficacy in reducing skeletal-related events and positively affecting the patients’ quality of life. The following chapter gives a concise overview of the underlying pathophysiology of bone metastases and data on pharmacological treatment options.