Introduction: The pattern of bone metastases and requirements for spinal surgery are well recognised in western countries. However, information on the origins, presentation and outlook are not well established in Sub-Saharan Africa. Materials and Methods: A cross-sectional study was conducted of cancer patients with metastatic bone disease presenting between November 2022 and April 2023. Data were collected from patients’ files, histopathology and radiology reports by structured questionnaire. Visual Analogue (VAS), Spinal instability neoplastic score (SINS) and Mirel’s scores were used to assess pain, instability and fracture risk. Neurological impairment was measured on The American Spinal Injury Association (ASIA) scale. Results: 72 consecutive patients were enrolled with a mean age of 69±11 years (75% male, 25% female). 65% presented with prostatic secondaries and 18% breast. 92% showed multiple deposits of which 93% were spinal, 53% pelvis and 21% femoral. 60% of deposits were osteoblastic on radiology and 24% osteolytic with a fracture rate of 31% at presentation. 68% of the long bone metastases required surgical stabilization (6 pathological fractures, 7 with Mirel’s score > 12) and 19% of the spinal metastases required surgical stabilization (9 SINS >13, 4 ASIA B). Conclusion: A different pattern of malignant bone disease was observed in patients presenting in Tanzania with an increased incidence of spinal deposits to that observed in more developed countries. Our data provide a baseline for analysis of factors influencing outcome with the aim of reducing skeletal related events especially relevant to spinal stability and the need for surgical intervention.