BACKGROUND: Metastases to the bone as the sole manifestation of recurrence of a gastric carcinoma are extremely rare. CASE REPORT: We herein report the case of a 63-year-old man operated a year and a half before for a poorly differentiated gastric carcinoma affecting the fundus, who developed bilateral metastasis to the femoral head as the sole manifestation of recurrence. He was treated with radiotherapy to control pain with a poor response and both femoral heads had to be eventually resected. CONCLUSIONS: We review the literature on the rare occurrence of osseous metastasis from gastric carcinoma and comment briefly on the therapeutic options for these cases.