Risks and causes of bone cancer

We don’t know what causes most bone cancers. But there are some risks factors that can increase your risk of developing it. Some of these include your age, exposure to ionising radiation and inherited conditions.

What is a risk factor?

Anything that can increase your risk of getting a disease is called a risk factor.

Different cancers have different risk factors.­ Having one or more of these risk factors doesn't mean you will definitely get that cancer.

Age

Like most cancers, the risk of bone cancer increases with age. But for some types of bone cancer, younger people have a higher risk.

Osteosarcoma is more common in adolescents (10 to 19 years). It seems to be linked to the growth of the bones during puberty.

Ewing sarcoma usually develops in children and adolescents. But it can occur in adults.

Chondrosarcomas and spindle cell sarcomas tend to occur in adults between the ages of 30 to 60. 

Chordomas are more common in adults over 50 years of age.

Ionising radiation exposure

Exposure to high energy (ionising) radiation can cause cancer. This is because it can affect your cells and damage the DNA Open a glossary item.

Ionising radiation from medical tests such as x-rays or CT scans can increase your risk of developing bone cancer. But it is important you have these tests to get the right diagnosis and treatment. Your doctor balances the health risks of radiation from having these tests. Generally the health risks of radiation from tests are very low.   

Having radiotherapy for cancer in the past can increase your risk of developing bone cancer. This risk is highest if you have had radiotherapy as a child. Although past radiotherapy treatment is linked to a higher risk of developing cancer. The balance of this risk is out weighed by the need to treat the original cancer.

Previous treatment with chemotherapy

People who have had treatment with chemotherapy drugs called alkylating agents have an increased risk of developing bone cancer. The risk depends on how much treatment you have had. The risk may be higher if you are having it with radiotherapy. Alkylating agents include:

  • ifosfamide
  • etoposide
  • cisplatin
  • cyclophosphamide

It's important to remember that this risk is still very small compared to the risk to your health if the cancer had not been treated.

Other bone diseases

Some types of bone disease can increase the risk of bone cancer:

Enchondroma or osteochondroma

Enchondroma or osteochondroma are non cancerous (benign) bone tumours. If you have these tumours, you are at an increased risk of getting types of bone cancer called chondrosarcoma or osteosarcoma. This is very rare.

Ollier's disease 

Ollier's disease is a rare condition. It is also called enchondromatosis. People with this condition develop many non cancerous (benign) tumours in their bones. These tumours can become cancerous and can turn into chondrosarcoma.

Paget disease

People with Paget disease have an increased risk of getting osteosarcoma. Paget disease is a condition where new bone replaces old bones at a faster than normal rate.

Inherited conditions

Certain rare inherited conditions can increase the risk of developing bone cancer. These include:

Li-Fraumeni syndrome

A condition called Li-Fraumeni syndrome Open a glossary item runs in families. It is caused by a gene fault Open a glossary item inherited from your parents. If you have Li-Fraumeni syndrome, you have an increased risk of several cancers, including osteosarcoma. 

Hereditary retinoblastoma

There is a type of eye cancer also caused by faulty genes. It is called hereditary retinoblastoma. Children with this gene fault also have an increased risk of osteosarcoma.

The following syndromes are also risk factors for osteosarcoma:

  • Werner syndrome
  • Rothmund–Thomson syndrome
  • Bloom syndrome
  • Diamond Blackfan anaemia

Other possible causes

Stories about potential causes are often in the media and it isn’t always clear which ideas are supported by evidence. There might be things you have heard of that we haven’t included here. This is because either there is no evidence about them or it is less clear.

For detailed information on bone cancer risks and causes

  • Osteosarcoma
    H C Beird and others
    Nature Reviews. Disease Primers, December 2022. Volume 8, Number 77

  • Sarcoma treatment in the era of molecular medicine
    T G Grünewald and others
    EMBO Molecular Medicine, November 2020.  Volume 12, Issue 11, Page 11131

  • UK guidelines for the management of bone sarcomas 
    C Gerrand and others
    Clinical Sarcoma Research, May 2016. Volume 6, Number 7

  • Bone sarcomas: ESMO-EURCAN-GENTURIS-ERN PaedCane Clinical Practice Guidelines for diagnosis, treatment and follow-up
    S Strauss and others
    Annals of Oncology December 2021. Volume 32, Issue 12, Pages 1520 to 1536

  • Volumes 1–135a
    World Health Organization (WHO) website, last updated December 2023
    Accessed 21st May 2024

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular risk or cause you are interested in.

Last reviewed: 
17 Sep 2024
Next review due: 
17 Sep 2027

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