From the Guidelines
DISH, or Diffuse Idiopathic Skeletal Hyperostosis, is a condition characterized by abnormal bone growth along the spine and other areas of the skeleton, primarily affecting older adults over 50 years old, with a higher prevalence in men. This condition is associated with calcification and hardening of ligaments and tendons where they attach to bone, particularly along the right side of the spine, resulting in a distinctive "flowing" appearance of bone on X-rays, with at least four consecutive vertebrae showing fusion 1. Patients with DISH may experience stiffness, limited range of motion, and mild to moderate pain, though some remain asymptomatic. The condition is often linked to metabolic conditions like type 2 diabetes, obesity, and high blood pressure.
Key Characteristics of DISH
- Abnormal bone growth along the spine and other areas of the skeleton
- Primarily affects older adults over 50 years old
- Higher prevalence in men
- Calcification and hardening of ligaments and tendons
- Distinctive "flowing" appearance of bone on X-rays
- Associated with metabolic conditions like type 2 diabetes, obesity, and high blood pressure
Treatment and Management
Treatment of DISH focuses on symptom management through physical therapy, anti-inflammatory medications, and weight management 1. Regular monitoring and lifestyle modifications help most patients maintain good function despite the condition. It is essential to note that while DISH is a degenerative condition, it rarely causes severe disability, though it can increase fracture risk in advanced cases.
Important Considerations
- Regular monitoring is crucial to manage symptoms and prevent complications
- Lifestyle modifications, such as weight management and exercise, can help maintain good function
- Anti-inflammatory medications and physical therapy can help alleviate symptoms
- The condition is degenerative, but rarely causes severe disability
From the Research
Definition of DISH
- Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by the ossification and calcification of ligaments and entheses 2.
- It is also known as Forestier's disease, and is believed to be a variant of osteoarthritis (OA) without the degenerative intervertebral disc and joint degenerative qualities seen in classic OA 3.
- DISH is an ankylosing condition that affects up to 32.5% of the general cohort, and is characterized by flowing ossifications along the anterior spine spanning ≥4 vertebral bodies 4.
Clinical Features of DISH
- DISH is often asymptomatic, but affected individuals may present with back pain, stiffness, dysphagia, functional decline, and neurologic deficits 4.
- The presence of spinal or extraspinal ossifications can sometimes lead to symptoms including pain, stiffness, a reduced range of articular motion, and dysphagia, as well as increasing the risk of unstable spinal fractures 2.
- DISH is associated with older age, male sex, obesity, hypertension, atherosclerosis, and diabetes mellitus 5.
Diagnosis and Management of DISH
- Diagnosing the presence of DISH is of clinical importance, because the risk of a spinal fracture increases and associations with the metabolic syndrome, coronary and aortic disease, and respiratory effects are strong 5.
- The diagnosis of DISH requires the presence of multiple contiguous fully formed bridging ossifications, which probably represent advanced stages of DISH 2.
- The management of DISH involves careful consideration of the patient's condition, and may include treatment of underlying metabolic disease and prevention of unstable spine fractures 4.