diffuse idiopathic skeletal hyperostosis (DISH)

Last edited 11/2019 and last reviewed 12/2020

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly (1)

This is a common disease of the spine seen in the elderly. The most striking feature is the exuberant formation of degenerative osteophytes.

Often the condition is asymptomatic but it may present with stiffness and pain.

DISH is diagnosed when ossification of the anterolateral aspect of the anterior longitudinal ligament is present on at least four contiguous spinal levels without involvement of the intervertebral disk space and/or apophyseal (facet) joints (2)

• disease usually affects the thoracic spine
• other possible features include:
  • peripheral joints manifestations especially in the form of hypertrophic osteoarthritis (OA), osteoarthritis involving joints usually not affected by OA such as the elbow and shoulder, and enthesopathies related to joints (ie, tibial tuberosity, elbow) and in sites unrelated to joints (ie, plantar fascia, iliolumbar ligament

The disease can manifest itself also at extraspinal locations leading to peripheral entheseal ossification and bony spurs

DISH have found a prevalence ranging from 2.9% in the Korean population, to 10.0% in a Caucasian population with a male/female ratio of 2:1 in most investigations (3,4)

Other associations include (5):

• marked increase of the disease with advancing ages
• obesity
• diabetes mellitus

Reference:

• Belanger TA, Rowe DE.Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. J Am Acad Orthop Surg 2001;9:258-267
• Resnick D .Diffuse idiopathic skeletal hyperostosis. AJR Am J Roentgenol 1978;130:588-589
• Kim SK, Choi BR, Kim CG et al. The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol 2004; 31:2032-2035
• Weinfeld RM, Olson PN, Maki DD et al.The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol 1997; 26:222-225
• Kiss C, Szilagyi M, Paksy A et al. Risk factors for diffuse idiopathic skeletal hyperostosis: a case-control study. Rheumatology (Oxford) 2002; 41:27-30