Radiotherapy is an effective treatment for pain and other symptoms caused by bone and spine metastases, including spinal cord compression and cauda equina syndrome. The magnitude of pain relief is similar between single fraction and a short course of fractionated radiotherapy for bone metastases, but selected patients may benefit from a longer course based on prognosis and risk factors. Surgical evaluation is important for patients with existing or impending pathologic fracture and vertebral metastases causing instability. Prophylactic radiotherapy to prevent skeletal-related events in patients with asymptomatic metastatic disease, stereotactic ablative radiotherapy, targeted radionuclides, and reirradiation may play an increasingly larger role in the future. In this chapter, the role of radiotherapy in the treatment of bone metastases is summarized, with an emphasis on dose/fractionation, functional outcomes, and supportive care.