The skeleton is a frequent site of metastasis in patients with cancer. Multiple myeloma is a plasma cell malignancy in which 70-80% of patients present with lytic lesions in the skeleton (Terpos, 2013). Bone lesions, whether from metastatic carcinoma or multiple myeloma, can be painful and limit physical activity. They may require radiation therapy, surgery or both. Despite this import, no systematically produced CPG on the management of metastatic bone carcinoma, focusing on the risk and prevention of pathological fractures, has been created that includes the clinical insight of orthopaedic surgeons. The systematic reviews and clinical practice guidelines (CPGs) that exist on these topics have largely been limited. We have decided to focus on the femur, the most common long bone affected by carcinoma and myeloma. Fractures of the femur almost always require surgery and dramatically alter patients’ quality of life and potentially survival (Gendi, 2016). One important finding from this process was the paucity of high-quality evidence available for clinicians to make decisions regarding prevention and treatment of pathologic fractures of the femur. Search criteria required that all studies included had at least 10 patients per group and reported on study populations that were primarily comprised of metastatic carcinoma or multiple myeloma of the femur. The project design included 15 PICO (Patient, Intervention, Comparison, Outcome) questions and recommendations were formulated based on workgroup consensus. We believe this is a clinically important evidentiary gap that should stimulate clinical researchers and funding agencies in the future. As the treatment of patients with bone metastases involves multiple disciplines, this guideline was designed as a multidisciplinary effort from the outset. The project was initiated by the Musculoskeletal Tumor Society (MSTS), the primary national organization of orthopaedic oncologists.