Osteosarcoma is rare. About 1,000 new cases are diagnosed in the United States each year, making it one of the least common cancers overall. To put that in perspective, breast cancer produces roughly 300 times more new cases annually. Still, osteosarcoma is the most common primary bone tumor, and it disproportionately affects teenagers, which is why it gets more attention than its raw numbers might suggest.
Who Gets Osteosarcoma Most Often
Osteosarcoma follows an unusual two-peak pattern. The first and larger peak hits adolescents and young adults, with the highest incidence rate among 15- to 19-year-olds at about 8.4 cases per million. For children under 14, the rate is roughly half that, at 4.2 per million. The second, smaller peak appears in adults over 60, often linked to underlying bone conditions rather than the rapid growth that drives teenage cases.
Males develop osteosarcoma more often than females at an overall ratio of about 1.3 to 1. That gap is smallest in young children under 10, where incidence is roughly equal between sexes, and widens during the teenage years when boys tend to go through longer, more intense growth spurts. The sex difference narrows again in middle adulthood before reappearing in people over 60.
Differences Across Racial and Ethnic Groups
A large analysis of U.S. cancer registry data spanning 1975 to 2017 found that Black Americans had the highest osteosarcoma incidence of any racial group, with a rate of 4.1 per million across all ages. Hispanic Americans had the second-highest rate at 3.4 per million. Among teenagers and young adults specifically, osteosarcoma was most common in Black and Hispanic populations, with Hispanic males showing the highest incidence in the 10-to-24 age group.
Black Americans were also the only racial group with a statistically significant increase in osteosarcoma incidence over the full study period, rising at about 1.1% per year. The reasons for these disparities aren’t fully understood, but the pattern held across multiple age groups and persisted for decades.
Why Older Adults Develop Osteosarcoma
The second incidence peak in people over 60 often involves secondary osteosarcoma, meaning the cancer develops in bone that was already damaged or abnormal. The two main risk factors are Paget’s disease of bone and prior radiation therapy.
Paget’s disease, a condition where bone breaks down and rebuilds abnormally, affects up to 3% of people over 60. About 1% of those patients eventually develop osteosarcoma, and osteosarcoma accounts for more than 80% of all cancers that arise from Paget’s disease. The risk is highest in people who’ve had the disease for many years and in multiple bones. Prior radiation to any part of the skeleton, typically from treatment for a different cancer years earlier, is the other well-recognized trigger.
Genetic Factors and Inherited Risk
A surprisingly high proportion of osteosarcoma cases have a genetic component. Research estimates that roughly 28% of osteosarcoma patients carry inherited mutations in genes that strongly increase cancer risk. The most commonly involved gene is TP53, which causes Li-Fraumeni syndrome, a condition that dramatically raises the lifetime risk of several cancers including osteosarcoma. Mutations in the retinoblastoma gene (RB1) are the next most frequent, followed by mutations linked to rarer conditions like Rothmund-Thomson syndrome and Werner syndrome.
This doesn’t mean that 28% of cases run in families in an obvious way. Many of these mutations arise spontaneously or haven’t been identified in relatives. But it does mean that genetic testing is increasingly relevant for osteosarcoma patients and their families, especially when the cancer appears at a young age or alongside other cancers in the family.
Survival Rates by Stage
Outcomes depend heavily on whether the cancer has spread at the time of diagnosis. For localized osteosarcoma, meaning the tumor is confined to the bone and nearby tissue, five-year survival ranges from 60% to 75%. For children and teenagers specifically, survival rates are about 62% to 66% depending on age group, based on cases diagnosed between 2015 and 2021.
When osteosarcoma has already metastasized at diagnosis, typically to the lungs, five-year survival drops sharply to between 5% and 30%. That wide range reflects differences in how many metastatic sites are involved and how well the cancer responds to chemotherapy. About 4,110 new bone and joint cancers of all types are projected in the U.S. for 2026, with roughly 2,210 deaths, underscoring that bone cancers as a group remain serious despite their rarity.
Osteosarcoma in the Broader Cancer Landscape
Among all cancers, osteosarcoma barely registers statistically. It represents a tiny fraction of the roughly 2.1 million cancer diagnoses expected in the U.S. each year. But within specific populations, it looms larger. For teenagers aged 15 to 19, osteosarcoma is one of the more common solid tumors. And because it tends to strike during a physically active stage of life, often in the long bones around the knee, its impact on mobility and quality of life can be significant even when treatment is successful.
The rarity of osteosarcoma itself creates challenges. Clinical trials enroll slowly, new treatments take longer to develop and test, and many community oncologists may see only a handful of cases in their entire careers. Most osteosarcoma patients are treated at specialized cancer centers with dedicated sarcoma teams, where concentrated experience translates to better outcomes.