Purpose: Summarize current knowledge, critical gaps in knowledge, and recommendations to advance the field of metastatic bone cancer. Experimental Design: A multidisciplinary consensus conference was convened to review recent progress in basic and clinical research, assess critical gaps in current knowledge, and prioritize recommendations to advance research in the next 5 years. The program addressed three principal topics: biology of metastasis, preserving normal bone health, and optimizing bonetargeted therapies. Results: A variety of specific recommendations were identified as important to advance research and clinical care over the next 5 years. Conclusions: Priorities for research in bone biology include characterizing components of the stem cell niche in bone, developing oncogenic immunocompetent animal models of bone metastasis, and investigating the unique contribution of the bone microenvironment to tumor growth and dormancy. Priorities for research in preserving normal bone health include developing methods to measure and characterize disseminating tumor cells, assessing outcomes from the major prevention trials currently in progress, and improving methodologies to assess risks and benefits of treatment. Priorities for optimizing bone-targeted therapies include advancing studies of serum proteomics and genomics to reliably identify patients who will develop bone metastases, enhancing imaging for early detection of bone metastases and early response evaluation, and developing new tests to evaluate response to bone-directed treatments.Tumor metastasis to the skeleton affects over 400,000 individuals in the United States annually, more than any other site of metastasis, including significant proportions of patients with breast, prostate, lung, and other solid tumors (1). At present, once cancer metastasizes to bone, it is incurable and can cause severe morbidity and mortality. Bone metastases are often associated with skeletal-related events (SRE), which include severe pain, bone fractures, need for radiation therapy to bone, need for surgery to bone, spinal cord compression, and bone demineralization. Bisphosphonate therapy, the current standard of care for metastatic bone cancer, has been shown to decrease the risk of SREs by up to 50% and slow the rate of development of SREs (2). Although this therapeutic advance is of major clinical significance, bisphosphonate therapy does not completely block bone metastasis. In addition, bisphosphonate therapy is occasionally associated with renal toxicity and osteonecrosis of the jaw. Thus, new strategies are needed to develop bone-targeted agents to both