Aim: This study aimed to evaluate the histopathological spectrum of neoplastic and nonneoplastic bone lesions, providing insight into their clinical and pathological characteristics to aid in accurate diagnosis and management. Materials and Methods: A prospective study was conducted from 2022 to 2023 in the Department of Pathology at Government Medical College, Srinagar, involving 100 patients presenting with bone lesions. Detailed demographic and clinical data, including age, sex, and duration of symptoms, were collected. Biopsy specimens were obtained and processed for histopathological examination, using Hematoxylin and Eosin (H&E) staining, with additional special stains and immunohistochemistry as needed. Lesions were categorized into neoplastic (benign and malignant) and nonneoplastic (inflammatory and cystic) groups, and statistical analysis was performed using SPSS software version 25.0. Results: The study found that neoplastic lesions were more common in older patients, with a mean age of 45.2 years, compared to 37.8 years in nonneoplastic cases (p=0.042). Benign neoplastic lesions accounted for 35% of cases, while malignant lesions comprised 20%. Nonneoplastic lesions included osteomyelitis (40%) and simple bone cysts (22.22%). Neoplastic lesions were associated with longer symptom duration (p=0.015), larger lesion size (p=0.019), and higher serum alkaline phosphatase levels (p=0.004). Conclusion: This study highlights the diverse histopathological features of bone lesions, emphasizing the need for comprehensive evaluation to differentiate between neoplastic and nonneoplastic conditions. Identifying key clinical and serum markers can improve early diagnosis and guide effective treatment strategies, particularly for malignant tumors.