Causes of osteosarcoma

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This information has been written for patients, their families and friends, and the general public to help them understand more about osteosarcoma: what it is and the different types. This information is produced in accordance with BCRT's information policy.

What causes osteosarcoma and are there any risk factors?

Causes and risk factors are different. Risk factors are things that we know increase the chance of somebody developing osteosarcoma, but do not cause osteosarcoma in every case. An example of this is that being tall for your age is a risk factor for osteosarcoma – more cases of osteosarcoma are seen in taller people, but we can’t say that being tall is a cause of osteosarcoma because the vast majority of tall people will never develop osteosarcoma.

Causes of osteosarcoma

Although there has been a lot of research into possible causes of osteosarcoma, we still don’t understand what causes osteosarcoma in most cases. However, in 10-15% of people, a possible cause can be identified. Information about what causes a disease is called ‘aetiology’ (EE-tee-OL-loh-jee).

Identified causes include:

  • Radiotherapy (radiation treatment) for cancer can damage the DNA in bone cells and cause the cells to become cancerous.
  • Underlying bone abnormalities: Bones which already have something wrong with them are more likely to develop bone cancer, such as Paget’s Disease of Bone.
  • Genetic predisposition: damaged genes can be inherited from a person’s parents, making it more likely that a person will develop cancer.
Risk factors associated with osteosarcoma

Age, height and gender are all risk factors for osteosarcoma.

General risk factors

  • Age:  Osteosarcoma is more common in people between 10 and 24 years old.  During adolescence, bones grow very quickly.  It is thought that this rapid bone growth may be part of the reason why young people develop osteosarcoma more often during adolescence than younger children or older adults.

  • Height: Research has shown that patients who develop osteosarcoma are more likely to be taller than people of average height. 
    Osteosarcoma is also common in the long bones of tall dogs, such as Great Danes and Irish Wolfhounds.  This may be further evidence of a link between rapid bone growth and osteosarcoma.

  • Gender: Males have a slightly higher risk compared to females.  This could be simply because boys tend to be taller than girls. 

Inherited risk factors:

These are risk factors that people can be born with; these are inherited from one or both parents. A few inherited risk factors for osteosarcoma have been identified, but these are very rare and account for a small minority of osteosarcoma patients.

  • Retinoblastoma (REH-tih-noh-blas-TOH-muh)
    This is a rare, inherited childhood eye cancer that usually occurs when a baby inherits a damaged copy of a gene called Rb. In healthy cells this gene acts to stop cells dividing too quickly but if the gene is damaged then the chance of developing cancer increases.

    Children who have had retinoblastoma have a higher risk of osteosarcoma. It is thought that around 12% of retinoblastoma patients may develop osteosarcoma.

  • Li-Fraumeni (LEE-frau-MAY-nee) syndrome:
    This condition causes certain families to have a much higher risk of developing different kinds of cancer at a young age. The condition is caused by inherited damage to a gene called p53. p53 is one of the most important cancer-preventing genes and so if it is damaged risk of developing cancer increases. One of the many cancers that can develop is osteosarcoma.

People with other even rarer conditions have an increased risk of osteosarcoma. These include Rothmund-Thomson syndrome, which affects many parts of the body (slow growth, skin rashes, delayed bone formation and bones that do not form normally) and Werner’s syndrome, which is a condition that starts around the time of puberty and leads to the appearance of old age by 30-40 years of age.

Environmental risk factors

  • The only established environmental risk factor is from exposure to ionising radiation from previous radiotherapy treatment for cancer.

There has been some research into other possible environmental risk factors such as exposure to fluoride and pesticides, and previous treatments with chemotherapy drugs. More research is needed before we will know if these are risk factors. The Bone Cancer Research Trust is funding some of this research.

Paget's Disease of Bone

Although most cases of osteosarcoma are in teenagers and young adults, there is a second age group that sees a higher incidence, in adults aged over 55 years.

One risk factor for older patients to develop osteosarcoma is Paget’s Disease of Bone. Paget’s is a disease where the normal process of bone turnover is sped up so that bone is destroyed and replaced too rapidly. Because the new bone is created in a rush, it is not made properly and as a result the bones can become misshapen and painful. Alongside the bone pain there is an increased risk of developing osteosarcoma in these older patients.

Around 2% of patients with Paget’s Disease of Bone develop osteosarcoma.

The authors and reviewers of this information are committed to producing reliable, accurate and up to date content reflecting the best available research evidence, and best clinical practice. We aim to provide unbiased information free from any commercial conflicts of interest. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. BCRT can answer questions about primary bone cancers, including treatments and research but we are unable to offer specific advice about individual patients. If you are worried about any symptoms please consult your doctor.

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Version 2 produced January 2013
Information will be reviewed in January 2015

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