Bone metastases in thyroid cancer

•Osseous metastases (OMs) occur in only 4% of all thyroid cancer patients but are associated with greatly increased morbidity and mortality.•OMs are about twice as frequent in follicular, hurthle cell, and medullary thyroid cancers as compared to papillary thyroid cancers.•OMs are often lytic, triggered via activation of osteoclasts by tumor cells in a “vicious cycle”.•OMs are often initially asymptomatic, but associated with eventual skeletal related events in >75%.•Early identification of OMs, preemptive treatment with antiresorptive agents, and aggressive treatment of focal lesions before crisis are key.