DISH, Diffuse Idiopathic Skeletal Hyperostosis 4.08/5 (12)

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Diffuse idiopathic skeletal hyperostosis (DISH) (a). Vortex fracture (b). Diederichs G, E, Osteoporotic Fractures in Men Research Gro - Osteoporos Int (2010). Open


Diffuse idiopathic skeletal hyperostosis (DISH, Forestier's disease) causes chronic stiffness in the back, especially in the vertebral column (thoracic column) in people from 50-60 years of age. In X-ray or CT examinations, bridging calcifications are detected between several vertebrae and over the intervertebral discs. Lumbar columna and neck (cervical columna) may also be attacked in addition to the tendon attachments for Achilles tendons, kneecaps, hips, elbows and shoulders. However, not everyone has pain or other symptoms.

Disease Cause

One has investigated, but has not found that hard physical work, consuming a lot of lime, other dietary factors or hereditary conditions are crucial for the development of the disease.

  • The cause of the disease is thus unknown


DISH is detected with increasing age and is rarely before the age of 40.

  • However, at the age of 70, DISH occurs in the entire 5-10%, most often among males (reference Kiss C, O'Neil TW)

Symptoms of Diffuse Idiopathic Skeletal Hyperostosis (DISH)

DISH is first noticed as stiffness and back pain, mostly in the morning

  • Symptoms from the vertebral column are located between the scapula and down to the lower back
  • The incidence of pain varies
    • The changes in the back can be detected randomly, without any special symptoms being present
  • Some feel the feeling of tightness in the throat and swallowing problems because large calcifications in the neck swirl column can push against the esophagus


The diagnosis is made using X-rays or CT examinations as well as clinical assessment showing reduced mobility in the back.

  • Most typical of the x-rays are ossification between four or more consecutive vertebrae in the vertebral column, neck or lower back
  • Most often, the connective tissue is in front of the vertebrae and the intervertebral discs (anterior ligament) calcified, while the intervertebral discs are usually normal
  • Calcification behind vertebrae (posterior ligament) also occurs
  • There is no evidence of inflammation of the iliosacral joints such as wood Bekhterev's disease (ankylosing spondylitis) and internal organs are not damaged.
  • Diagnostic imaging can also show calcification in the late festivals Achilles Ener, kneecap, hips, elbows and shoulders.

Classification criteria (Utsinger- criteria, Reference: Outputs PD, 1985)

  1. Continuous calcification along the anterior part of the vertebrae and intervertebral discs, preferably in the thoracic vertebral column. The calcifications begin as narrow bands, but usually develop into broad, uneven thicknesses.
  2. Continuous calcification along the front of at least two consecutive vertebrae
  3. Sidelik (symmetrical) calcifications / ossifications in the tendon attachments behind the heel (Achilles tendon), at kneecaps or elbows.

Exclusion: Abnormally low intervertebral discs, calcifications based on joints (apophysic joints) that cause rigidity

Interpretation of the criteria: Point 1: Safe DISH. Point 2 + 3: possible DISH


The treatment is aimed at any symptoms. As with lumbago, the measures consist of adapted physical activity and exercises.


The prognosis is generally good, but increasing stiffness over time results in reduced physical function.

  • Those most severely affected are prone to fractures in the back in the event of injuries


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