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Paget's Disease Complication — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicinePaget's Disease ComplicationRACP Adult Medicine

A 62-year-old man with known Paget's disease of bone presents with increasing pain in his left tibia despite bisphosphonate therapy. Alkaline phosphatase has risen from 350 to 1200 U/L over 6 months. Plain X-ray shows a destructive lytic lesion with soft tissue extension. What complication should be suspected?

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Correct answer: E — Osteosarcoma

Osteosarcoma is the most feared complication of Paget's disease, occurring in <1% of cases but carrying a very poor prognosis. A rapidly rising ALP with a destructive lytic/mixed lesion and soft tissue component in the setting of known Paget's disease should raise high suspicion. MRI and biopsy are required. Survival is poor despite chemotherapy and surgery.

Reference: eTG – 2025 – Rheumatology; NHMRC – 2018 – Paget's Disease