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Difference Between Paget’s Disease and Osteosarcoma

Paget’s disease is a condition where the way that bone is replaced is disrupted. Osteosarcoma is a primary malignant bone cancer affecting osteoid cells.

What is Paget’s disease?


Paget’s disease of the bones is when there is a problem with the bone deposition and removal cycle.

Causes and prevalence:

The cause of the disease is genetic mutations, such as that of the gene Sequestosome 1 (SQSTM1). Paget’s disease occurs in people who are older than 45; it is most common in people older than 80 (10% of individuals).

Symptoms and complications:

There may at first not be many symptoms of Paget’s disease. When symptoms do develop, they include stiffness and fatigue, bone deformities, and pain. The skull may enlarge at the sides and front. Frontal enlargement is known as frontal bossing. Other symptoms may include headaches, and bone deformities such as bowing of the legs and a curved backbone. Complications include osteoarthritis, deafness, and nerve compression.


Diagnosis is made by X-ray imaging and blood tests.  X-rays will show increased bone density in places and unusual bone structures. Blood tests will reveal higher than normal levels of phosphate, calcium, and alkaline phosphatase. A radionucleotide bone scan shows the stage of the disease.


The usual treatment is to give bisphosphonates, nonsteroidal anti-inflammatory drugs (NSAIDs), or analgesic medications. Synthetic salmon calcitonin is sometimes given instead of bisphosphonates. 

What is Osteosarcoma?


Osteosarcoma is a type of malignant bone cancer that affects osteoid cells of the bone. 

Causes and prevalence:

Genetic mutations seem to increase the risk of osteosarcoma. The gene mutations for the RB1 gene and Li-Fraumeni syndrome (TP53 gene) have been implicated in osteosarcoma. Other causes may include previous exposure to radiation due to treatment given for another type of cancer. Osteosarcoma is the most common of all the bone cancers and usually affects teenagers.

Symptoms and complications:

The symptoms of osteosarcoma include pain in the affected bone, a lump where the tumor is, redness, swelling, limited ability to move the affected limb. Bone fracture is also a possible sign of osteosarcoma. The cancer most often affects the long bones and the knee joint.  The main complication is that the cancer is malignant and often spreads to the lungs. The cancer can be lethal with survival at about 60% at 5 years.


Diagnosis of osteosarcoma includes X-rays and a biopsy of the bone. X-ray images often show sclerotic regions of bone where the cancer is. Chest X-rays may be done to check for metastasis to the lungs.


Treatment options usually include surgery to remove the bone tumor; in some cases, a limb may be amputated. The patient is also often also given several rounds of chemotherapy.

Difference betweenPaget’s disease and Osteosarcoma?


Paget’s disease is linked to problems in bone turnover. Osteosarcoma is a type of bone cancer.


Paget’s disease is most common in people who are middle-aged and older, so age 50 and older. Osteosarcoma is common in people between ages 10 and 30, but most prevalent among teenagers.


Fatigue, stiffness, deformed bone, and pain are symptoms of Paget’s disease. Pain, swelling, redness and a lump are symptoms of osteosarcoma.


Complications of Paget’s disease are nerve compression, deafness, arthritis, and, in rare cases, cancer. Complications of osteosarcoma are metastasis to the lung and death. 


Paget’s disease is treated with bisphosphonates. Osteosarcoma treatment may include surgery, limb amputation, and chemotherapy.


It is rare for Paget’s disease to cause death unless it develops into cancer. In the case of osteosarcoma, about 60% of people survive 5 years.

Table comparing Paget’s disease and Osteosarcoma

Summary ofPaget’s disease Vs. Osteosarcoma

  • Paget’s disease affects bone in terms of how bone is broken down and built up.
  • Osteosarcoma is a primary malignant bone cancer.
  • In rare cases, Paget’s disease can lead to bone cancer but most often it does not.


What can be mistaken for Paget’s disease?

Arthritis, osteoporosis, and spinal stenosis can be confused with Paget’s disease.

What is the difference between Paget’s and osteoporosis?

Osteoporosis is porous bones due to demineralization. Paget’s disease of bone is when there is unusual breakdown and development of bone tissue.

Can Paget’s disease lead to bone cancer?

Yes, although it is rare, Paget’s disease can develop into bone cancer.

Can Paget’s disease of the bone be misdiagnosed?

Yes, the disease can be misdiagnosed as another bone condition because some of the symptoms like bone pain, are similar to other conditions.

What 4 bones are often affected by Paget’s disease?

The bones usually affected by Paget’s disease include the spine, pelvis, head, and legs.

Can Paget’s disease be non cancerous?

Yes, it is common for Paget’s disease to not develop into cancer.

What initial symptom of Paget’s disease is?

Bone pain is the usual symptom that patients with the disease first are aware of.

What is the first line of treatment for Paget’s disease?

The first line of treatment in Paget’s disease is to give bisphosphonates.

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References :

[0]Charles, Julia F. “Paget Disease of Bone (Paget’s Disease of Bone, Osteitis Deformans). Merckmanuals. Merck & Co., 2022, https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/paget-disease-of-bone/paget-disease-of-bone#

[1]Joyce, Michael J. and David M. Joyce. “Primary Malignant Bone Tumors”. Merckmanuals. Merck & Co., 2022, https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/tumors-of-bones-and-joints/primary-malignant-bone-tumors#v910184

[2]Ralston, Stuart H., Anne L. Langston, and Ian R. Reid. "Pathogenesis and management of Paget's disease of bone." The Lancet 372.9633 (2008): 155-163.

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