Bone health has an increasingly significant clinical importance in the management of oncology patients. First, bone metastases are common in many solid tumors, particularly advanced breast, prostate and lung cancers, and multiple myeloma, which can cause fractures, severe pain, nerve compression, hypercalcemia, and bone marrow suppression. Second, many tumor patients receive treatments that affect hormone levels associated with bone remodeling, accelerating bone loss. Third, the bone marrow microenvironment is also closely related to the process of tumor dissemination and metastasis. Multidisciplinary treatment, including the application of bone-targeted therapies such as bisphosphonates or denosumab, can reduce bone complications and alleviate bone pain and improve patients’ quality of life. On April 29, AnnOncol published online the new European Society of Medical Oncology (ESMO) Clinical Practice Guidelines for Bone Health in Oncology Patients. This article summarizes the key points of the guidelines. The differential diagnosis includes osteoporosis, degenerative disease, and Paget’s disease; isotope bone scan is more sensitive in detecting skeletal pathologic changes but yields less information on the nature of the lesion; CT and magnetic resonance imaging (MRI) provide the best information on bone structure; positron emission tomography (PET) provides a functional aid to diagnosis; Dual-energy X-ray absorptiometry (DXA) is performed in patients with accelerated bone loss from tumor treatment. Patient assessment Assessment of the patient’s symptoms and activity status is important; bone radiography can assess response to treatment, but information is delayed and methodologically insensitive; isotope bone scan is not useful for monitoring response to treatment; biochemical markers of bone metabolism can provide information on prognosis and response to bone-specific treatment, but are not recommended for routine clinical use. Treatment Prevention of bone metastases Bisphosphonates reduce bone metastases and improve survival in postmenopausal women with breast cancer and do not improve disease outcomes in premenopausal women (Class I Evidence Level A recommendation); denosumab delays bone metastases in desmoresistant prostate cancer (Class I Evidence Level B recommendation). Prevention of treatment-induced bone loss Bisphosphonates and denosumab may prevent bone loss in early-stage breast cancer treated with ovarian suppression or aromatase inhibitors and in prostate cancer treated with androgen deprivation therapy (Class I, Level B recommendation). Treatment of bone metastases Multidisciplinary management that includes systemic therapy, radiotherapy, orthopedic surgery, radiology, and palliative support is effective in the treatment of bone metastatic disease (Class V, Level B); radiotherapy is a palliative treatment option for localized bone pain (Class II, Level B); single and multiple fractionated radiotherapy are equally effective in relieving bone pain (Class I, Level A). Bisphosphonates and denosumab inhibit the activity of osteoclasts, delaying bone complications, relieving symptoms, and improving patients’ quality of life, and have become important agents for the treatment of bone metastases (Class I evidence Level A recommendation); zoledronic acid is the most effective bisphosphonate for the prevention of bone metastases, and denosumab is more effective than zoledronic acid for the prevention of bone lesions in solid tumors (Class I evidence Level B recommendation); bone-targeted therapy should be initiated at the time of diagnosis of Bone metastatic lesions should be initiated at the time of diagnosis and maintained during the course of the disease (Class III evidence). Note: Level of evidence: Class I evidence comes from at least one randomized controlled trial of good methodological quality (little bias) or a meta-analysis of well executed randomized trials without heterogeneity. Class II evidence came from meta-analyses of small randomized trials or large randomized trials of low methodological quality (suspected bias) or heterogeneous trials. Class III evidence was obtained from prospective cohort studies. Class IV evidence came from retrospective cohort studies or case-control studies. Class V evidence comes from studies without a control group, case reports, or expert opinion. Recommendation level: Class A is a strong recommendation with clear clinical benefit effect and strong evidence. Class B is a general recommendation with limited clinical benefit and strong or moderate evidence. Note: a includes aromatase inhibitors and ovarian suppression therapy or ovariectomy for androgen deprivation therapy in breast and prostate cancer; b if patients have ≥ 10% reduction in bone mineral density (taking the lower T value of the spine and hip) per year (or ≥ 4% to 5% reduction at baseline bone loss) using the same DXA instrumentation, secondary factors causing bone loss such as vitamin D deficiency should be excluded and inhibition of Bone resorption-inhibiting therapy; C can be applied intravenously with zoledronic acid for 6 months, weekly oral alendronate or risedronate or monthly oral ibandronate; d denosumab may be a potential treatment option for some patients; e although osteonecrosis of the jaw occurs less frequently with osteoprotective doses of bone-resorption-inhibiting drugs, routine dental care and attention to oral hygiene are still recommended.