Microwave ablation (MWA) is a percutaneous thermal ablation technique that has emerged as a valuable alternative for treating bone tumors. It belongs to a broader group of thermal ablation therapies, including radiofrequency ablation (RFA), cryoablation (CO), and high-intensity focused ultrasound (HIFU). Image-guided tumor ablation offers significant advantages over surgical treatment, including shorter recovery times, lower morbidity and mortality, reduced procedural costs, precise targeting with ultrasound or CT guidance, immediate therapeutic effects, and a favorable safety profile. Additionally, MWA can be performed in an outpatient setting, reducing hospital stays and allowing for repeated treatment in cases of residual tumor burden. MWA differs from other thermal ablation modalities by achieving higher intratumoral temperatures while being less affected by tissue conductivity and impedance variations. This makes it particularly effective for treating bone lesions, where variability in tissue composition can impact thermal energy distribution. MWA is indicated for both curative and palliative purposes. In curative cases, it is employed in benign bone tumors, selected primary malignant tumors, and specific patients with oligometastatic disease. In palliative settings, MWA is used to treat painful bone metastases that are refractory to conventional therapies, including pharmacologic management, radiotherapy, and surgery. Absolute contraindications include lack of safe access, acute immunosuppression, active infection, uncorrected coagulopathy, and patient refusal. Relative contraindications include proximity to crucial neurovascular structures and organs. In conclusion, MWA is a powerful and minimally invasive technique for managing bone tumors. As clinical evidence grows, its indications continue to expand. However, appropriate patient selection, consideration of tumor size and location, and careful procedural planning are essential to maximize efficacy and minimize complications.