OBJECTIVES: To determine the burden of bone metastases and health resource utilisation (HRU) associated with skeletal-related events (SREs) in patients with advanced cancer. METHODS:  This observational study assessed HRU associated with SREs (defined as spinal cord compression [SCC], surgery to bone [SB], pathologic fracture [PF] or radiation to bone [RB]). Patients with breast, lung or prostate cancer metastatic to bone or multiple myeloma and life expectancy >6 months were enrolled in centres in Germany, Italy, Spain, UK, Canada and USA after experiencing a SRE. We report here the European HRU data on hospitalisation, which were collected retrospectively for the 90 days prior to enrolment and prospectively for approximately 18-21 months. RESULTS:  631 eligible patients with a total of 1282 SREs were enrolled across 95 European sites: 223 (35.3%) had a primary diagnosis of breast cancer, 135 (21.4%) lung cancer, 120 (19%) prostate cancer and 153 (24.3%) multiple myeloma. Across all tumour types, for Germany, Italy, Spain and UK, respectively, the mean number of hospitalisations per SCC (n = 91) was 0.85, 0.69, 0.53 and 1.06 with a mean length of stay (per SRE with ≥ 1 hospitalisation) of 25.6, 41.1, 34.3 and 27.7 days. For SB (n = 137) mean number of hospitalisations per SRE was 0.90, 0.76, 0.83 and 0.75 with mean stays of 19.4, 19.8, 8.4 and 10.0 days, respectively. For PF (n = 254), mean number of hospitalisations per SRE was 0.42, 0.49, 0.49 and 0.39 with mean stays of 18.7, 22.4, 20.2 and 20.7 days, respectively. Mean number of hospitalisations per RB (n = 692) were 0.19, 0.15, 0.16 and 0.07 with mean stays of 17.9, 16.6, 21.9 and 10.4 days respectively. CONCLUSIONS:  Each SRE leads to considerable hospitalisation, which varies by SRE type and country.