Background: Pathological fracture is one of the consequences from MBD, which can worsen the prognosis and can deplete the quality of patients lives. Looking at those effects, predicting the pathological fracture in MBD patients needs to be done. Objective: Determine the correlation of risk factors for pathological fractures in long bone metastatic disease and determine the accuracy of the Mirels scoring system. Method: This was a retrospective research based on the medical record data and x-ray photos of patients with long bone metastases at Dr. Soetomo General Academic Hospital in 2019-2021. We determined the correlation of risk factors by using the likelihood-ratio test. Result: Of the total of 39 long bone metastases cases, there were 28 cases (71.79%) followed by pathological fracture, and 11 of them (28.21%) were not. From the calculation of Mirels score, 36 cases had scores of ≥ 9 (impending), and 3 of them had scores of 8 (borderline). Most metastases were located in the lower extremities (48.7%), sized >2/3 cortex (48.7%), lytic type (79.5%), and with functional pain (82.1%). %). Conclusion: There was a correlation between the location of upper extremity lesions sized > 2/3 cortex, lytic type, and functional pain with the incidence of fracture (p < 0,05) and the percentage of Mirels scoring system accuracy in predicting the incidence of pathological fractures was 66.67%.