Bone tumors account for a small fraction of childhood cancers. Most published reports are from developed countries. The purpose of this study was to review the primary bone tumors in children and adolescents treated at a referral center in Northern Tanzania. We completed a 10-year hospital-based cross-sectional study in which all patients younger than 20 years diagnosed with a primary bone tumor at the Kilimanjaro Christian Medical Center Orthopaedic Department from January 2006 to December 2015 were identified and reviewed. Of the 80 identified patients, 15 (18.8%) were aged 5 to 8 years, and 65 (81%) were aged 9 to 19 years. Forty-seven males (59%) and 33 females (41%) were identified. The most common tumor locations were the femur, tibia, and humerus. Osteosarcoma was the most common malignant diagnosis (49 patients, 61%). No cases of Ewing sarcoma were reported. The most common tribal origins of the patients were Chagga and Maasai. Most primary bone tumors treated at a referral center in Northern Tanzania are malignant, with osteosarcoma representing the vast majority. No cases of Ewing sarcoma were identified in this tertiary referral hospital–based database.