Despite adjuvant treatment for early-stage breast cancer (BC), up to 30% of patients develop distant metastatic disease. Bone is the most common site for metastasis from BC, and bone metastases are especially prevalent in hormone receptor-positive (HR+) metastatic breast cancer (MBC). Bone involvement can lead to skeletal-related complications such as fractures, bone pain, spinal cord compression, and hypercalcemia, which can significantly impact mobility and quality of life. Bone-only metastases (BOM), a pattern of metastasis in which bone is the only site of metastasis from breast cancer, occur in 25% of patients with MBC. MBC with BOM is associated with improved prognosis compared to those who also have metastasis in visceral organs like the lung, liver, or brain. Treatment strategies vary by receptor subtype. Endocrine therapy with CDK4/6 inhibitors followed by targeted therapy is normally used for HR+/HER2– MBC, while HER2+ and triple-negative MBC typically requires chemotherapy with targeted therapies. Bone-modifying agents, such as denosumab and bisphosphonates, reduce SREs and improve quality of life. Although MBC remains incurable, survival is improving with novel therapies.