Diffuse Idiopathic Skeletal Hyperostosis (DISH)
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- Characterized by calcification and ossification of soft tissues, primarily ligaments and entheses; most commonly in the spine, especially thoracic segments
- Typically defined as flowing calcification across four or more contiguous vertebral segments with preservation of disc spaces
- Synonym(s): Forestier disease; vertebral ankylosing hyperostosis
- Diffuse idiopathic skeletal hyperostosis (DISH) is typically asymptomatic; it may, however, decrease spinal mobility and predispose patients to fractures after only mild trauma.
- DISH and osteoarthritis (OA) may coexist. Both affect the same population (elderly and obese).
- Bone mineral density (BMD) measurements obtained by dual energy x-ray absorptiometry (DEXA) and quantitative CT may not be accurate (falsely high) due to lumbar ossification/calcification in DISH.
- DISH should be considered in elderly patients with unexplained respiratory distress or dysphagia (1).
- Most common in elderly, obese males
- Prevalence varies geographically.
Incidence increases with age and is higher in men.
- Difficult to calculate due to variable classification criteria used across literature
- Japan: 19.5% (2)
- Thought to be similar in other populations
Etiology and Pathophysiology
- The etiology is unknown. Increased levels of insulin, insulin-like growth factor 1, and transforming growth factor-β1 are believed to stimulate osteoblasts and bone proliferation (1).
- Low serum levels of bone formation inhibitors (e.g., bone morphogenetic protein 2 or Dickkopf-1 [DKK-1], an inhibitor of the Wnt pathway required for new bone formation) may also play a role in DISH and are associated with more severe spinal involvement (1).
- Male gender
- Increased BMI
- Metabolic syndrome
- Lumbar spondylosis and knee OA
Control modifiable risk factors and the associated metabolic diseases.
Commonly Associated Conditions
Metabolic derangements associated with DISH:
- Obesity; large waist circumference
- Diabetes; hyperinsulinemia/insulin resistance
- Metabolic syndrome