Osteosarcoma: An Evolving Understanding of a Complex Disease

John H. Alexander, MD; Odion T. Binitie, MD; G. Douglas Letson, MD; David M. Joyce, MD


J Am Acad Orthop Surg. 2021;29(20):e993-e1004. 

In This Article


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.[1] Among this cohort, the peak occurs slightly earlier in females, an observation attributed to their earlier peak growth velocity.[1] 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.[1] 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.[1] 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.[1]