Background: Percutaneous biopsies have a good sensitivity and specificity for the diagnosis of bone lesions. Aim: To report the experience with 270 percutaneous bone lesions biopsies guided with fluoroscopy or computed tomography. Material and Methods: Retrospective review of the medical records of 270 patients (mean age 53.4 years, range 4 to 95 years; 134 female) subjected to a percutaneous biopsy of a bone lesion, guided either by computed tomography or fluoroscopy. The final analysis included the tumor type, tumor malignancy, tumor grade and complications of the procedure. Results: One hundred seventy nine lesions were malignant and 91 benign. Of the malignant lesions, 95 were metastatic and 84 were primary. In 3 cases, the initial diagnosis was a false negative (1.1%). Only one patient had a local hematoma after the procedure. Conclusions: Image guided percutaneous biopsy of bone lesions is a safe, effective, fast and economic procedure to obtain a pathological diagnosis of bone lesions