Introduction <p>Metastatic patients face the risk of pathological fractures (PF). The incidence of PF varies among different cancer types, impacting patient survival and leading to substantial healthcare costs. However, conflicting findings regarding the survival impact of PF exist, and comprehensive meta-analyses addressing this issue are currently lacking. The aim of this study was to evaluate the survival of metastatic cancer patients with PF.</p> Methods <p>This study adhered to PRISMA guidelines and employed the PICOS strategy for inclusion criteria. A comprehensive search was conducted across multiple databases. The primary focus was on survival outcomes. Statistical analysis employed Review Manager 5.4.1, calculating mean differences for continuous variables and generic inverse variances for hazard ratios. Heterogeneity was assessed using Chi2 and I2 tests.</p> Results <p>A total of eight studies with 15,464 patients were included. Unadjusted hazard ratios (HRs) showed that PF increased the risk of mortality 1.45 (95% CI 1.22 to 1.73). Adjusted HRs confirmed significant increase in mortality risk for PF HR 1.31 (95% CI 1.08 to 1.57). The PF group had significant lower mean survival (MD -14.50, 95% CI -22.95 to -6.05). PF increased the risk of mortality in breast cancer (HR 1.52, 95% CI 1.32 to 1.76), prostate cancer (HR 1.38, 95% CI 1.16 to 1.64) and in leiomyosarcoma (HR 5.40, 95% CI 1.80 to 16.2).</p> Conclusion <p>PF increases the mortality risk and reduces the mean survival of patients with metastatic cancer.</p>