Appropriate ED management includes analgesia, radiographic diagnosis, and initial communication with oncology.  Most bone metastases are sensitive to radiation therapy. Those with unknown primary carcinoma require an extensive workup that is typically facilitated as an inpatient.  Patients with pathologic fractures require orthopedic consultation to assess possible surgical options, such as palliative stabilization.  Final disposition can be determined with the oncologist and depends on analgesia, whether the primary malignancy is known, management plan, and availability of rapid follow-up.