Real-world incidence of symptomatic skeletal events and bone-modifying agent use in castration-resistant prostate cancer – an Australian multi-centre observational study

•Symptomatic skeletal events (SSEs), an important complication of bone metastases, occurred in 28% of our cohort.•Many SSEs occurred early (48%), before additional systemic therapy for castration-resistant prostate cancer (CRPC).•Bone-modifying agents (BMAs) delay the development of SSEs in patients with CRPC and bone metastases.•In our multi-centre registry, BMA use was only 46%, with variability in schedules.•A greater proportion of patients at sites with lower BMA use developed SSEs (32% vs 22%, p = 0.019).