Bone metastases are a frequent complication of solid tumors, leading to significant skeletal sequelae that negatively
impact quality of life and survival. Prevention and management of skeletal-related complications are critical treatment goals in
oncology. Endpoints used in clinical trials to evaluate skeletal-related complications have evolved. In contrast to single
measures of bone health, contemporary clinical trial endpoints reflect composite measures of skeletal-related complications, and
increasingly also survival. In addition, key symptomatic components, which are more reflective of quality of life and the patient
experience, are being incorporated. Given the evolution and resulting diversity of the endpoints being used in pivotal trials, it
is becoming increasingly relevant to clarify the utility and the potential clinical impact of these measures not only within the
context of trials but also in the real-world setting. Here, we describe the development and evolution of skeletal endpoints used
in trials, and discuss their clinical relevance.