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047). Presence of osteolytic metastases (HR 3.85, 95% CI 1.52-9.77p=0.005) but not occurrence of SREs was associated with impaired overall survival. Among the 36 patients who received ART (no ART n=71), SREs were significantly less frequent than in untreated patients (p=0.04). CONCLUSION Bone metastases are common in metastatic MTC and most often with an osteolytic morphology and an unfavorable prognosis. The majority of SREs occur in osteolytic metastases and may be prevented by anti-resorptive treatment. © Endocrine Society 2020. All