Diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis

Description, Causes and Risk Factors:

Abbreviation: DISH.

Diffuse idiopathic skeletal hyperostosis (DISH) is considered a form of degenerative arthritis or osteoarthritis. However, DISH is characterized by unique, flowing calcification along the sides of the contiguous vertebrae of the spine. And, very unlike typical degenerative arthritis, it's also commonly associated with inflammation (tendinitis) and calcification of tendons at their attachments points to bone. This can lead to the formation of bone spurs, such as heel spurs. In fact, heel spurs are common among individuals with DISH. DISH has also been called Forestier's disease.

Diffuse idiopathic skeletal hyperostosis

It is not known what causes DISH. DISH is associated with the metabolic syndrome and is more frequent in people with diabetes mellitus.

Risk Factors:

    Certain medications. Long-term use of medications called retinoids, that are similar to vitamin A can increase your risk of diffuse idiopathic skeletal hyperostosis. It isn't clear whether high intake of vitamin A increases your risk, however.

  • Sex. Men are much more likely to develop diffuse idiopathic skeletal hyperostosis.

  • Older age. Diffuse idiopathic skeletal hyperostosis is most common in older adults, especially in people older than 50.

  • Diabetes and other conditions. People with type 2 diabetes may be more likely to develop diffuse idiopathic skeletal hyperostosis than are those who don't have diabetes. Other conditions that may raise insulin levels in your body may also increase your risk, including hyperinsulinemia, prediabetes and obesity.

Diffuse idiopathic skeletal hyperostosis appears to be a phenomenon rather than a disease. Double-blind controlled evaluation (in which controls and patients were drawn from the same population) revealed no associated pathology. Arthritis, bursitis, and tendinitis appeared no more frequently in patients with DISH than in controls. Any back pain present was no different in character or duration than that noted in control subjects. A history of back injury was actually found to be twice as frequent in control subjects as it was in patients with DISH. Back flexibility was no more limited in patients with DISH than it was in controls. In fact, patients with DISH who had decreased lumbar spinal motion had a lower frequency of back pain, implying that DISH may be protective.


The signs and symptoms you experience depend on which part of your body is affected by diffuse idiopathic skeletal hyperostosis. The upper portion of your back (thoracic spine) is most commonly affected. Signs and symptoms may include:

    Pain. You may feel pain when someone presses on the affected area. Not everyone with diffuse idiopathic skeletal hyperostosis experiences pain.

  • Stiffness. Stiffness may be most noticeable in the morning.

  • Loss of range of motion. Loss of lateral range of motion may be most noticeable. You flex your spine laterally when you do side stretches, for example.

  • Difficulty swallowing or a hoarse voice. You may experience these symptoms if you have diffuse idiopathic skeletal hyperostosis in your neck (cervical spine).


To determine whether you have diffuse idiopathic skeletal hyperostosis, your doctor may begin with a physical examination. He or she will press lightly on your spine and joints to feel for abnormalities. Any pain you experience from the pressure on your spine may be a clue to the diagnosis. Diffuse idiopathic skeletal hyperostosis may cause pain at the point where the affected tendon or ligament attaches to a bone. Your doctor may be able to detect bone spurs.

Your doctor also will order imaging tests to help with the diagnosis. Tests that may be used include:

    X-rays. Your doctor will order X-rays to confirm a diagnosis of diffuse idiopathic skeletal hyperostosis.X-rays may show calcification along the bones that make up your spine (vertebrae). The calcification has a distinct appearance that doctors sometimes refer to as cascading or flowing. Some compare the appearance to that of candle wax dripping and oozing down your spine.

  • Computerized tomography (CT) and magnetic resonance imaging (MRI). These tests can rule out conditions that may cause similar signs and symptoms, such as ankylosing spondylitis.


While there's no cure for diffuse idiopathic skeletal hyperostosis, there are steps you can take to reduce pain and stiffness if you're experiencing those symptoms. In many cases, treatment may not be necessary. However, if you experience symptoms of diffuse idiopathic skeletal hyperostosis, your doctor may recommend treatments to control pain and maintain range of motion in your affected joints.

Treatment for pain: Treatment for pain caused by diffuse idiopathic skeletal hyperostosis is similar to that of other joint ailments. Your doctor may recommend acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). More severe pain can be treated with corticosteroid injections.

Treatment for stiffness: Physical therapy can reduce the stiffness associated with diffuse idiopathic skeletal hyperostosis. Exercises may also increase your range of motion in your joints. Ask your doctor about specific exercises you can do. He or she may refer you to a physical therapist for further guidance.

Surgery: Surgery may be required in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who experience difficulty swallowing due to large bone spurs in the neck may need surgery to remove the bone spurs. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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