Diffuse Idiopathic Skeletal Hyperostosis (DISH)

What is Diffuse Idiopathic Skeletal Hyperostosis?

Diffuse idiopathic skeletal hyperostosis, also known as DISH, is a condition where the ligaments that attach to your spine harden due to calcification. Another name for it is Forestier’s disease.

DISH may not have any symptoms and it might not even require treatment. It can affect the neck and lower back or even shoulders, knees, heels, and elbows. It can be a progressive conditions and it can have serious complications.

Calcium is usually used by the body to strengthen bones and teeth but it also circulates in the bloodstream. Calcium can deposit in different areas usually without creating any issues but great amounts of circulating calcium, damaged tissues and a series of underlying diseases can lead to heavy calcification in blood vessels and other random areas such as ligaments that can trigger serious diseases such as DISH.

What are the Symptoms of Diffuse Idiopathic Skeletal Hyperostosis?

Although there are many with DISH who have no symptoms at all there are many who do experience symptoms in affected areas.

Symptoms include

It can be minimal symptoms like stiffness (usually mostly in the morning).

It can also cause pain in the affected areas.  Some have a loss of range of motion that they especially notice when they are stretching from side to side.  Those who have DISH in their neck may have a hoarse voice or have difficulty swallowing.

Diffuse Idiopathic Skeletal Hyperostosis Causes

The causes of Diffuse Idiopathic Skeletal Hyperostosis (DISH) currently remain unknown, but researchers have identified factors that may increase the risk of an individual contracting the illness. For example, gender and age definitely play a role in who is most likely to contract DISH. Men have a higher probability of developing the condition than women and adults over the age of 50 are also more susceptible to contracting DISH.

Other risk factors revolve around most conditions that can cause a spike in one’s insulin levels. Examples of such conditions are hyperinsulinemia, prediabetes, and obesity. Additionally, those diagnosed with type 2 diabetes are at a higher than normal risk of developing diffuse idiopathic skeletal hyperostosis. Also, long term use of some medications, especially retinoids, can increase one’s risk of contracting DISH. Isotretinoin, which is similar to vitamin A, is one such example, though it’s unclear if vitamin A itself would increase the risk.

How is Diffuse Idiopathic Skeletal Hyperostosis Treated?

Since there is not a cure for diffuse idiopathic skeletal hyperostosis, treatment aims to reduce stiffness and pain and prevent the condition and symptoms from getting worse. There are some correlations between DISH and other diseases like type 2 diabetes, obesity, and insulin resistance so treat may focus on addressing these conditions to minimize or stop the progression of DISH.

Pain for DISH can be treated with over-the-counter or pain relievers like ibuprofen or acetaminophen.  Corticosteroid injections can help deal with more severe pain.

For stiffness related to DISH, physical therapy has proven to be helpful. Doctors may also recommend exercises that you can do at home.

Finally, in instances where DISH causes serious complications, surgery may be recommended.  It may be required to remove bone spurs in the neck or relieve spinal cord pressure.

Diffuse Idiopathic Skeletal Hyperostosis Prevention

There’s a lack of research on the prevention of diffuse idiopathic skeletal hyperostosis at present, but some risks can be reduced through lifestyle changes and through the careful monitoring of blood levels. For example, obesity and diabetes are two major factors that increase the risk of contracting the condition, though moderate lifestyle changes may reduce the probability of developing DISH symptoms.

Generally, maintaining a healthy weight and sticking to a balanced and nutritional diet will go a long way to reducing one’s risk of contracting DISH. A diet rich in vegetables, whole grains, lean meats, and fruits, while low in added sugar and sweeteners are necessary for managing obesity and diabetes, as well as reducing the risk of contracting diffuse idiopathic skeletal hyperostosis. Doctors also suggest that daily exercise can reduce the risk of developing DISH, as well as helping to relieve other illnesses that may prompt the onset of diffuse idiopathic skeletal hyperostosis.