Fifty-four patients with metastatic bone disease were followed prospectively to assess the risk of pathologic fracture during rehabilitation. Sixteen fractures were observed in 12 patients. Only one fracture occurred while the patient was undergoing rehabilitation, and this was a fourth lumbar vertebral compression that did not affect the clinical course of the patient. Patients in the fracture group were generally younger, female, and in a more advanced stage of disease with lytic metastases and a previous occurrence of pathologic fracture.