Extra-axial bone augmentation is a durable, safe, and effective method for pain relief in patients with metastatic cancer or lytic lesions of the bone. Prior methods of fracture prevention and fixation within the pelvis included morbid surgeries with curettage and complex open arthroplasty requiring significant recovery time. Utilizing multiple osseous corridors within the acetabulum and pelvic ring, large bore cannulated screws in combination of bone cement, or photodynamic polymer implants have been shown to significantly decrease Visual Analog Pain scores, decrease narcotic usage, and increase functional scores with minimal complications and early recovery. There are multiple techniques, but an emphasis on mechanical stabilization of the periacetabular region has been shown to be effective. Studies have shown some patients may require simple arthroplasty after this procedure. These techniques have also been shown to increase functional scores when performed for lesions within the sacrum; however, care must be taken to account for individualized anatomy and proximity to nerve roots. Bone augmentation in the extremities has traditionally been performed through open techniques, given the lower morbidity of surgery; however, early studies on bone augmentation are ongoing. Early results show higher failure rates than traditional intramedullary nailing despite equivalent pain control. Overall, bone augmentation can significantly improve pain and function in patients with lytic lesions within the extra-axial skeleton.