Osteosarcomas and chondrosarcomas are the most common primary bone sarcomas. They are often highly aggressive neoplasms that rapidly progress and eventually recur and give distant metastases. Although the prognosis and quality of life have been improved during the last decades, the pathogenesis of these tumours remains elusive. Recent advances in molecular genetics and cytogenetics have brought a wealth of genes and molecular pathways that govern osteoblast and chondroblast differentiation and maturation, providing a better understanding of the biology of osteogenetic and cartilage tumours. In this review we describe the major tumour suppressor and oncogenic pathways, as well as the most important signal transduction cascades implicated in the development and progression of these malignancies. Furthermore, we discuss novel treatment regimens and future, patient-tailored strategies that will add significantly to the current therapeutic armamentarium.