Patients with primary sarcomas of bone and soft tissue are generally treated on protocol by a multidisciplinary team at tertiary referral centers. Conversely, patients with metastatic disease to the skeleton are often evaluated by general orthopaedic surgeons in the community. Skeletal metastases affect a growing percentage of the elderly population and can contribute to a marked decrease in their quality of life. Treatment includes stabilization with the latest prosthetic implants and new devices. Advances in the field of radiation oncology and bisphosphonate use in patients with bone metastasis are other management approaches.