A cancer diagnosis in emergency departments (EDs) is often associated with advanced or metastatic cancer. Patients with bone metastases have a complex range of physical and psychological needs. Meeting the needs of patients with cancer is an important part of the role of emergency nurses, but evidence suggests that they often do not feel adequately prepared to provide effective care for this patient group. This article uses a case study of a patient who presented to an ED with metastatic cancer in his right lower limb, to provide an overview of bone metastases, including the relevant anatomy, pain management and psychological support. The article also outlines the signs and symptoms of bone metastases and discusses patient assessment, symptom management and available treatments. © 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.