While the management of bone metastases requires multidisciplinary care, external beam radiotherapy (EBRT) remains an effective and efficient method by which to palliate pain and prevent pathologic fracture. Dose fractionation schemes ranging from 8 Gy in a single fraction to 30 Gy in ten fractions can provide equivalent relief with a minimal risk of side effects. Highly conformal or stereotactic body radiation therapy shows promise in the treatment of these patients, with its most appropriate niches to be determined through continued accrual to ongoing clinical trials. Treatment guidelines and quality measures have been developed to better define the use of EBRT in the setting of painful bone metastases.