Diffuse Idiopathic Skeletal Hyperostosis (DISH)
- 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
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Domino, Frank J., et al., editors. "Diffuse Idiopathic Skeletal Hyperostosis (DISH)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688208/all/Diffuse_Idiopathic_Skeletal_Hyperostosis__DISH_.
Diffuse Idiopathic Skeletal Hyperostosis (DISH). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688208/all/Diffuse_Idiopathic_Skeletal_Hyperostosis__DISH_. Accessed May 29, 2023.
Diffuse Idiopathic Skeletal Hyperostosis (DISH). (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688208/all/Diffuse_Idiopathic_Skeletal_Hyperostosis__DISH_
Diffuse Idiopathic Skeletal Hyperostosis (DISH) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 29]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688208/all/Diffuse_Idiopathic_Skeletal_Hyperostosis__DISH_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diffuse Idiopathic Skeletal Hyperostosis (DISH) ID - 1688208 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688208/all/Diffuse_Idiopathic_Skeletal_Hyperostosis__DISH_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -