Abstract: Metastasis of cancer cells accounts for the vast majority of cancer deaths. In many cases, tumor cells metastasize long after treatment or resection of the primary tumor. Bone has been reported to be the first organ with evidence of metastasis in breast cancer. Due to the special microenvironment in bone, disseminated tumor cells (DTCs) have strong immune escape and drug resistance. Therefore, understanding the interaction between DTCs and bone microenvironment, and the key factors regulating the occurrence of secondary metastasis of DTCs, is the core of pathophysiology of bone metastasis. This review presents an overview of the survival period for breast cancer patients with bone metastasis, the alterations in the bone microenvironment, and the molecular mechanisms driving the bone metastasis process. It explores therapeutic approaches focusing on the constituents and interaction mechanisms within the bone microenvironment, aiming to provide some valuable insights for the prevention and treatment of breast cancer bone metastasis.