Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Basics

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

Geriatric Considerations

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).

Incidence
Incidence increases with age and is higher in men.

Prevalence

Difficult to calculate due to variable classification criteria used across literature
Japan: 19.5% (2)
Thought to be similar in other populations

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).

Control modifiable risk factors and the associated metabolic diseases.

Metabolic derangements associated with DISH:

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