Metabolic bone diseases (MBDs), including osteoporosis, osteomalacia, and Paget's disease, represent a significant challenge in medical imaging and intervention. Interventional radiologists play a pivotal role in managing these conditions, due to the crucial role of detailed and precise imaging in diagnosing and treating MBDs. This article offers comprehensive recommendations aimed at optimizing interventional radiologic practices for patients with MBDs, highlighting the importance of using advanced imaging modalities, including dual-energy X-ray absorptiometry and magnetic resonance imaging, essential for accurate assessment of bone mineral density and architecture, guiding effective intervention strategies. We also discuss the use of minimally invasive procedures like vertebroplasty and biopsy, vital for both diagnostic and therapeutic purposes, to enhance diagnostic accuracy and therapeutic outcomes, ensuring high-quality patient management in the context of MBDs.