Purpose: Bone is one of the most common sites of metastases in patients with advanced lung cancer. Skeletal complications may cause significant morbidity and decrease performance status (PS). Such complications, referred to as skeletal related events (SREs), include severe bone pain, pathological fractures, spinal cord compression, and hypercalcemia of malignancy. We assessed the clinical impact of SREs in non-small lung cancer (NSCLC) patients with bone metastases. Methods: We retrospectively investigated the clinical records of all 120 patients who were diagnosed advanced NSCLC with bone metastases between June 1998 and March 2009. Results: A total of 23 patients (26.7%) were found to have SREs at the time of initial diagnosis. The median survival time (MST) was 123 days for patients with SREs, while it increased to 276 days for those without SREs. The MST of the patients with SREs were significantly shorter than that of the patients without SREs (p<0.001). We also studied the SREs during clinical courses of 89 patients whose records were available over 3 months. A total of 39 patients (43.8%) were found to have SREs during clinical courses. Conclusion: The patients in NSCLC with bone metastases were often found to have SREs. SREs cause significant morbidity and deterioration of PS. Systemic chemotherapy could not decrease SREs during their clinical courses. Further studies evaluating bisphosphonates in combination with chemotherapy are warranted. Palliat Care Res 2010; 5(2): 145-151