ab17_4

Osteoporosis with lymphoid nodules and hematopoietic marrow hyperplasia

M. Laroche¹, I. Ludot², P. Brousset³, B. Mazières¹

¹Department of Rheumatology, Rangueil University Hospital; ²Laboratory for Research in Bone and Joint Pathology, Rangueil University Hospital; ³Department of Anatomo-pathology, Purpan University Hospital, Toulouse, France.

ABSTRACT
Objective
In 1983 Vigorita reported 3 cases of osteoporosis associated with intra-medullary lymphoid nodules. We present 8 patients with osteoporosis and lymphoid nodules (LN) in whom we studied the clinical, biological and histological features and the course of the disease.

Methods
Three men (mean age 52 yrs., range 43 - 68 yrs.) and 5 women (mean age 60 yrs., 49 - 66 yrs.), 6 of them with osteoporosis with fracture and 2 with osteoporosis on bone densitometry (T score < -2.5 SD) were enrolled in this study. The following parameters were studied: immunobinding with IG determination, phosphorus and calcium levels, PTH, 25 and 1-25 OH D3, osteocalcin, urinary deoxypyridinoline, histomorphometry, tests for autoantibodies, HIV, HTLV, EBV and CMV serology. The results were compared with those of 20 patients with osteoporosis but without LN. Five patients underwent a second BMB a mean of 2 years after the first.

Results
Five patients had asthenia, 4 had joint pain and 3 had hyperlymphocytosis. Immunologic and virologic investigations were negative in all cases. Bone marrow was hypercellular (59.9 ± 5.3 vs 40.1 ± 13%, p: 0.001). At the second BMB, LN were absent but bone marrow was still hypercellular. In all cases, no cause of demineralization was found and osteoporosis progressed rapidly (an average of 3 vertebral compression fractures in 3 months, with increased resorption (ES 6.5 ± 1.6 vs 3 ± 1.2, p: 0.05) with decreased calcification rate (CR 0.62 ± 0.07 vs 0.79 ± 0.1, p : 0.04).

Conclusion
Some interesting questions are raised by this study. Did an undiscovered viral infection cause the asthenia and joint pain via cytokines or PTHrp in our patients, and can activated lymphocytes perhaps modify bone remodeling ?

Key words
Osteoporosis, lymphoid nodules.

Please address correspondence and reprint requests to: Dr. M. Laroche, Service de Rhumatologie, Centre Hospitalier Universitaire Rangueil, 1 avenue Jean Poulhès, F-31403 Toulouse Cedex 4, France.