Diffuse Idiopathic Skeletal Hyperostosis

What is diffuse idiopathic skeletal hyperostosis (DISH)?

Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disorder that causes ligaments and tendons in the body to calcify (harden). These calcified areas can also form bone spurs (abnormal new bone growth) that can cause pain, stiffness, and decreased mobility.

While DISH usually affects the spine, it can also occur in other areas throughout the body. DISH is a type of arthritis. It is also called Forestier’s disease.

How common is diffuse idiopathic skeletal hyperostosis (DISH)?

DISH is uncommon in people under 40 years old. It develops more often in people over 50. It affects more men than women.

What causes diffuse idiopathic skeletal hyperostosis (DISH)?

DISH is caused by calcification and the abnormal growth of new bones. Calcification happens when ligaments and tendons harden because of a buildup of calcium salts. Doctors are not certain what causes these conditions to occur.

What are the symptoms of diffuse idiopathic skeletal hyperostosis (DISH)?

Some people with DISH have no symptoms. Doctors find the condition when examining X-rays taken for a different reason.

When symptoms of DISH do occur, they include:

• Numbness or tingling in legs
• Pain
• Reduced mobility
• Stiffness
• Trouble swallowing or hoarseness (abnormal voice changes) if DISH develops in the neck

How is diffuse idiopathic skeletal hyperostosis (DISH) diagnosed?

A doctor diagnoses DISH with imaging tests, including X-rays and CT scans. These tests enable your doctor to see the bony growths.

Diagnostic tests help doctors rule out conditions that involve similar symptoms, including other types of arthritis.

How is diffuse idiopathic skeletal hyperostosis (DISH) managed or treated?

Treatment cannot stop the calcification or bone growth associated with DISH. Instead, treatment aims to manage symptoms and keep the condition from progressing (getting worse).

Treatment options for DISH include:

• Applying heat: Warm compresses can ease stiffness and pain.
• Medication: Doctors may recommend drugs to manage pain, including:
  • Over-the-counter pain relievers and non-steroidal anti-inflammatory drugs
  • Corticosteroid injections
  • Muscle relaxants
• Physical therapy: Specific exercises can help improve mobility.
• Surgery: Doctors sometimes treat DISH with surgery in cases where the bone overgrowth presses on nerves or causes trouble breathing.

What complications are associated with diffuse idiopathic skeletal hyperostosis (DISH)?

If DISH develops in the ligament that runs along the spine, it can compress (put pressure on) the spinal cord and cause paralysis. Other complications that people with DISH may experience include:

• Chronic (ongoing) pain
• Increased risk of bone fractures (breaks)
• Loss of mobility in the affected area
• Sleep apnea (disorder that causes breathing problems during sleep)
• Trouble breathing or swallowing

Can diffuse idiopathic skeletal hyperostosis (DISH) be prevented?

You can reduce your risk of DISH by maintaining a healthy weight and blood sugar levels. Limiting your use of medications containing vitamin A also may make you less likely to develop DISH.

What are the risk factors for diffuse idiopathic skeletal hyperostosis (DISH)?

People at higher risk for DISH include those who:

• Are age 50 or older
• Are male
• Have diabetes or are obese
• Have been exposed to high levels of vitamin A over a long period

What is the prognosis (outlook) for people with diffuse idiopathic skeletal hyperostosis (DISH)?

DISH does not affect life expectancy. Many people with DISH can successfully manage their symptoms and live healthy, active lives.

If left untreated, some symptoms of DISH can get worse over time. It is important to get prompt treatment to ease symptoms and keep them from progressing (getting worse).

When should I call the doctor?

Contact your doctor if you develop any signs or symptoms of DISH.

What questions should I ask my doctor?

If you have DISH, you may want to ask your doctor:

• How will DISH affect my home and work life?
• What are my treatment options?
• What complications should I watch out for?
• Does DISH change my likelihood of developing other types of arthritis?

When can I go back to my regular activities?

Many people with DISH do not have any symptoms. They can keep up their routines as usual.

If you receive treatment for symptoms, your doctor will let you know when you can get back to your usual activities.