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Risks and causes

Find out what causes bone cancer, including lifestyle factors and other medical conditions.

We don’t know what causes most bone cancers. But there are some factors that may increase your risk of developing it.

Having any of these risk factors does not mean that you will definitely develop cancer.

Risks and causes

Some types of bone cancer are most common in younger people.

Osteosarcoma is most common in teenagers and young adults. It seems to be linked to growth of the bones during puberty. Osteosarcoma also becomes more common again in older people. This might be in part due to Paget's disease which mainly occurs in the elderly.

Ewing's sarcoma usually develops in young people between 10 to 20 years of age. But it can occur in children and older adults.

Chondrosarcomas and spindle cell sarcomas tend to occur mostly in adults over the age of 35 to 40.

Chordomas occur mostly in adults over 60 years of age.

The risk of bone cancer seems to be linked to previous treatment with radiotherapy and chemotherapy. This increase in risk may not just be to do with the treatment. It may also be due to the cancers sharing risk factors such as gene faults, which increase the risk of bone cancers and other cancer types. For example, bone sarcoma and a type of childhood cancer called retinoblastoma are linked with the same gene fault.

Radiotherapy

Exposure to radiation can cause bone cancer. If you have had radiotherapy in the past to an area of the body that includes bones, you have an increased risk of getting an osteosarcoma in that area. This is a very small risk for most people.

Childhood cancer

Research shows that people who survived cancer in childhood, compared with the general population, have a higher risk of bone cancer. The risk is higher for:

  • those who had cancer at a younger age
  • those who had radiotherapy or treatment with a type of chemotherapy called alkylating drugs
  • people who had kidney cancer, soft tissue sarcoma or bone sarcoma

Having had cancer before

People who have had bone cancer before have a higher risk of getting a second bone cancer. And bone cancer risk is higher in people who have had non-Hodgkin lymphoma (NHL). The risk of bone cancer is also higher in people who have had radiotherapy for:

  • mouth cancer
  • anal cancer
  • rectal cancer
  • cervical cancer

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

Paget's disease

If you have had Paget’s disease of the bone, you have a slightly increased risk of getting an osteosarcoma. This mainly occurs in people older than 60 years.

Chondroma or osteochondroma

If you have a type of non cancerous (benign) bone tumour called a chondroma or osteochondroma, you have an increased risk of getting a type of bone cancer called chondrosarcoma.

Ollier's disease 

A rare condition called Ollier's disease (also called enchondromatosis) increases the risk of developing a chondrosarcoma. People with Ollier's disease develop many non cancerous (benign) tumours in their bones. Around 40 out of 100 people with this condition (40%) will develop chondrosarcoma. 

Maffucci's syndrome

Maffucci's syndrome is a condition similar to Ollier's disease. People with Maffucci's syndrome have non cancerous tumours in their bones, as well as abnormally shaped bones. Up to around 60 out of 100 people with Maffucci's syndrome (60%) develop chondrosarcoma.

Some genetic factors are linked with bone cancer.

 Li-Fraumeni syndrome

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

 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.

Hereditary multiple exostoses (HME)

A rare genetic condition called HME (hereditary multiple exostoses) can increase the risk of developing a chondrosarcoma later in life.

Neurofibromatosis

This is a genetic disease in which non cancerous (benign) tumours form in the nerves under the skin and in other parts of the body. Some research shows this increases the risk of getting a bone sarcoma. 

Down's syndrome

A study has also shown that the risk of osteosarcoma is higher in children and adolescents with Down's syndrome.

Some people who have relatives with particular types of cancer have an increased risk of certain types of bone cancer but this is very rare. This includes:

  • giant cell sarcoma in people whose mother had breast cancer
  • osteosarcoma in people with a parent who had rectal cancer or liver cancer
  • Ewing’s sarcoma in people with a parent who had kidney cancer
  • Ewing's sarcoma in people who have a first degree relative with melanoma or bone cancer

A first degree relative is someone in your family with the most direct connection to you. So that means your mother, father, brother or sister, or child.

People with a mother diagnosed with breast cancer before the age of 45 have almost 5 times the risk of bone cancer compared to the general population. But because bone cancers are relatively rare this is still a small risk.

If you are born heavier than average for your sex, you have a higher risk of ostesarcoma later in life than people with an average birth weight. 

People who are taller than average for their age and sex have an increased risk of osteosarcoma, compared with average-height people.

Children born with a hernia of the tummy button (a congenital umbilical hernia) are around 3 times more likely to have a Ewing’s sarcoma. An umbilical hernia is caused by a weakness of the muscle around the belly button.

Researchers think as the embryo grows, factors that contribute to an umbilical hernia also make the child more likely to develop Ewing's sarcoma.
 

A study of Ewing’s sarcoma over a period of 30 years in America showed that white Americans have a risk of this type of bone cancer that is nine times higher than black Americans. It is not clear why this is.
 

Injuries and knocks

People often think that a knock or injury to a bone can cause a cancer. But research studies do not support this.

It's more likely that an injury causes swelling, which shows up a cancer that is already there. Or a bone affected by cancer may be weakened and so is more likely to become damaged in an accident. Doctors may then spot the tumour when they are investigating your accident.
 

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

Last reviewed: 
27 Jan 2014
  • Bone sarcoma: incidence and survival rates in England
    The National Cancer Intelligence Network (NCIN), 2012

  • Cancer and its management (6th edition)
    J Tobias and D Hochhauser
    Blackwell, 2010

  • Bone sarcoma statistics from Cancer Research UK (Cancer Stats) 
    Accessed 2014

  • Sarcoma arising in Paget's disease of bone: declining incidence and increasing age at presentation 
    DC Mangham and others.
    Bone, 2009. Volume 4, Issue 3

  • Incidence and mortality of second sarcomas - a population-based study.  
    B Bjerkehagen and others. 
    European Journal of Cancer, 2013. Volume 49, Issue 15

  • 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.

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