Osteosarcoma has a bimodal age distribution; the first peak incidence (7 to 8 per million) occurs during the adolescent growth spurt between ages 10 and 19 years. Among this cohort, the peak occurs slightly earlier in females, an observation attributed to their earlier peak growth velocity. A second peak incidence of 4.2 cases per million is seen in patients over the age of 60 and accounts for approximately 20% of osteosarcoma diagnoses. Although secondary osteosarcomas associated with preexisting bone disease (Paget disease and bone infarcts) or arising in a previous radiation field account for 34% of these adult diagnoses, most of the cases in this cohort remain de novo. Overall, osteosarcoma affects males more commonly than females (1.22:1), with the exception being patients aged 15 years and younger among which females have a higher incidence than males. Finally, based on Surveillance, Epidemiology, and End Results data, osteosarcoma has a higher incidence among Blacks than Whites and Other races; however, this difference is dependent on age, presence of underlying Paget disease, and secondary malignancies.
J Am Acad Orthop Surg. 2021;29(20):e993-e1004. © 2021 American Academy of Orthopaedic Surgeons