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Genetics Home Reference: your guide to understanding genetic conditions     A service of the U.S. National Library of Medicine®

Hereditary multiple exostoses

Reviewed January 2013

What is hereditary multiple exostoses?

Hereditary multiple exostoses is a condition in which people develop multiple benign (noncancerous) bone tumors called exostoses. The number of exostoses and the bones on which they are located vary greatly among affected individuals. The exostoses are not present at birth, but approximately 96 percent of affected people develop multiple exostoses by the time they are 12 years old. Exostoses typically form at the end of long bones and on flat bones such as the hip and shoulder blade. Once people with hereditary multiple exostoses reach adult height and their bones stop growing, the development of new exostoses also usually stops.

Multiple exostoses can disrupt bone growth and can cause growth disturbances of the arms, hands, and legs, leading to short stature. Often these problems with bone growth do not affect the right and left limb equally, resulting in uneven limb lengths (limb length discrepancy). Bowing of the forearm or ankle and abnormal development of the hip joints (hip dysplasia) caused by exostoses can lead to difficulty walking and general discomfort. Multiple exostoses may also result in pain, limited range of joint movement, and pressure on nerves, blood vessels, the spinal cord, and tissues surrounding the exostoses.

Exostoses are typically benign; however, in some instances these tumors become malignant (cancerous). Researchers estimate that people with hereditary multiple exostoses have a 1 in 20 to 1 in 200 lifetime risk of developing cancerous exostoses (sarcomas).

How common is hereditary multiple exostoses?

The incidence of hereditary multiple exostoses is estimated to be 1 in 50,000 individuals. This condition occurs more frequently in some isolated populations: the incidence is approximately 1 in 1,000 in the Chamorro population of Guam and 1 in 77 in the Ojibway Indian population of Manitoba, Canada.

What genes are related to hereditary multiple exostoses?

Mutations in the EXT1 and EXT2 genes cause hereditary multiple exostoses. The EXT1 gene and the EXT2 gene provide instructions for producing the proteins exostosin-1 and exostosin-2, respectively. The two exostosin proteins bind together and form a complex found in a cell structure called the Golgi apparatus, which modifies newly produced enzymes and other proteins. In the Golgi apparatus, the exostosin-1 and exostosin-2 complex modifies a protein called heparan sulfate so it can be used by the cell.

When there is a mutation in exostosin-1 or exostosin-2, heparan sulfate cannot be processed correctly and is nonfunctional. Although heparan sulfate is involved in many bodily processes, it is unclear how the lack of this protein contributes to the development of exostoses.

If the condition is caused by a mutation in the EXT1 gene it is called hereditary multiple exostoses type 1. A mutation in the EXT2 gene causes hereditary multiple exostoses type 2. While both type 1 and type 2 involve multiple exostoses, the severity of symptoms associated with exostoses seems to be greater in type 1.

Researchers estimate that about 15 percent of people with hereditary multiple exostoses have no mutation in either the EXT1 or the EXT2 gene. It is not known why multiple exostoses form in these individuals.

Related Gene(s)

Changes in these genes are associated with hereditary multiple exostoses.

  • EXT1
  • EXT2

How do people inherit hereditary multiple exostoses?

This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder.

In some cases, an affected person inherits the mutation from one affected parent. Other cases result from new mutations in the gene and occur in people with no history of the disorder in their family.

Where can I find information about diagnosis or management of hereditary multiple exostoses?

These resources address the diagnosis or management of hereditary multiple exostoses and may include treatment providers.

  • Gene Review: Hereditary Multiple Osteochondromas (
  • Genetic Testing Registry: Multiple congenital exostosis (
  • Genetic Testing Registry: Multiple exostoses type 2 (

You might also find information on the diagnosis or management of hereditary multiple exostoses in Educational resources and Patient support.

General information about the diagnosis ( and management ( of genetic conditions is available in the Handbook. Read more about genetic testing (, particularly the difference between clinical tests and research tests (

To locate a healthcare provider, see How can I find a genetics professional in my area? ( in the Handbook.

Where can I find additional information about hereditary multiple exostoses?

You may find the following resources about hereditary multiple exostoses helpful. These materials are written for the general public.

You may also be interested in these resources, which are designed for healthcare professionals and researchers.

What other names do people use for hereditary multiple exostoses?

  • Bessel-Hagen disease
  • diaphyseal aclasis
  • exostoses, multiple hereditary
  • familial exostoses
  • multiple cartilaginous exostoses
  • multiple congenital exostosis
  • multiple hereditary exostoses
  • multiple osteochondromas
  • multiple osteochondromatosis

For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines ( and How are genetic conditions and genes named? ( in the Handbook.

What if I still have specific questions about hereditary multiple exostoses?

Ask the Genetic and Rare Diseases Information Center (

What glossary definitions help with understanding hereditary multiple exostoses?

autosomal ; autosomal dominant ; benign ; cell ; congenital ; dysplasia ; exostoses ; familial ; gene ; Golgi apparatus ; heparan sulfate ; hereditary ; incidence ; inherited ; joint ; mutation ; population ; protein ; short stature ; stature ; sulfate

You may find definitions for these and many other terms in the Genetics Home Reference Glossary.


  • Alvarez CM, De Vera MA, Heslip TR, Casey B. Evaluation of the anatomic burden of patients with hereditary multiple exostoses. Clin Orthop Relat Res. 2007 Sep;462:73-9. (
  • Jäger M, Westhoff B, Portier S, Leube B, Hardt K, Royer-Pokora B, Gossheger G, Krauspe R. Clinical outcome and genotype in patients with hereditary multiple exostoses. J Orthop Res. 2007 Dec;25(12):1541-51. (
  • Pedrini E, Jennes I, Tremosini M, Milanesi A, Mordenti M, Parra A, Sgariglia F, Zuntini M, Campanacci L, Fabbri N, Pignotti E, Wuyts W, Sangiorgi L. Genotype-phenotype correlation study in 529 patients with multiple hereditary exostoses: identification of "protective" and "risk" factors. J Bone Joint Surg Am. 2011 Dec 21;93(24):2294-302. doi: 10.2106/JBJS.J.00949. (
  • Pei Y, Wang Y, Huang W, Hu B, Huang D, Zhou Y, Su P. Novel mutations of EXT1 and EXT2 genes among families and sporadic cases with multiple exostoses. Genet Test Mol Biomarkers. 2010 Dec;14(6):865-72. doi: 10.1089/gtmb.2010.0040. Epub 2010 Nov 1. (
  • Pierz KA, Stieber JR, Kusumi K, Dormans JP. Hereditary multiple exostoses: one center's experience and review of etiology. Clin Orthop Relat Res. 2002 Aug;(401):49-59. (
  • Porter DE, Lonie L, Fraser M, Dobson-Stone C, Porter JR, Monaco AP, Simpson AH. Severity of disease and risk of malignant change in hereditary multiple exostoses. A genotype-phenotype study. J Bone Joint Surg Br. 2004 Sep;86(7):1041-6. (
  • Stieber JR, Dormans JP. Manifestations of hereditary multiple exostoses. J Am Acad Orthop Surg. 2005 Mar-Apr;13(2):110-20. Review. (


The resources on this site should not be used as a substitute for professional medical care or advice. Users seeking information about a personal genetic disease, syndrome, or condition should consult with a qualified healthcare professional. See How can I find a genetics professional in my area? ( in the Handbook.

Reviewed: January 2013
Published: February 1, 2016