A state-of-the-art review of the molecular underpinnings of bone-seeking cancers, current treatment approaches for them, and future therapeutic strategies. The authors illuminate the role of various autocrine, paracrine, and immunological factors involved in the progression and establishment of bone metastases, highlighting the physiological processes that lead to bone degradation, pain, angiogenesis, and dysregulation of bone turnover. They also discuss the various strategies that appear to have promise and are currently deployed in treatment or are at the experimental stage.