Bone tumor organoids (BTOs) are three-dimensional culture systems developed from patient-derived tissues, which accurately replicate the growth dynamics and cellular interactions characteristic of bone tumors in vitro. Organoids offer improved physiological relevance compared to traditional models, thereby enhancing the precision of therapeutic strategies and addressing existing treatment limitations. The effectiveness of current bone tumor therapies is often limited by issues such as drug resistance, recurrence, and metastasis. While still in early stages, organoid technology has shown promise in studying various types of bone tumors, including primary, metastatic, and bone marrow–origin tumors. Here we outline the methodologies for establishing bone tumor organoids, highlight their current and potential applications across different bone tumor subtypes, and examine their integration with novel technologies. Furthermore, this review discusses existing challenges and future research directions.