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Background: Metastatic carcinoma is the most common secondary malignant tumor affecting the bone. Bone is the third most common site for metastasis after lung and liver. The present study was planned to analyze the histomorphological patterns of bone changes in metastatic tumors and their correlation with the radiological findings. Materials and Methods: The current prospective study was conducted over a span of 2 years, encompassing 150 patients with clinically and radiologically suspected metastatic bone disease. Bone biopsy samples were studied for the pattern of bone changes. Results: Of 150 total cases, 30 cases had metastatic bone tumors. The age of the patients ranged from 37 to 84 years (mean: 57.57 ± 11.9 years). Male-to-female ratio was 2:1. All patients with metastasis presented with a complaint of pain followed by tenderness (20, 66.7%). The lesions were commonly located in the vertebral column (14, 46.7%), followed by femur (6, 20%). The primary site was known in 21 (70%) cases. The tumor histotypes were adenocarcinoma (23, 76.7%), squamous cell carcinoma (5, 16.7%), pleomorphic sarcoma (1, 3.3%), and malignant melanoma (1, 3.3%). Histomorphological patterns of bone changes were osteolytic (16, 53.3%), mixed (8, 26.7%), and osteoblastic (6, 20.0%). Correlation between the radiological findings and histopathological patterns of metastases was found to be statistically significant. Conclusions: Histomorphological assessment of bone changes in metastasis is an important parameter. Besides the histological categorization of metastatic bone disease, it plays a pivotal role in identification of the primary tumor site.