Diffuse idiopathic skeletal hyperostosis


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What is diffuse idiopathic skeletal hyperostosis?

Diffuse idiopathic skeletal hyperostosis (DISH) is considered a form of degenerative arthritis or osteoarthritis. However, DISH is characterized by unique, flowing calcification along the sides of the contiguous vertebrae of the spine. And, very unlike typical degenerative arthritis, it’s also commonly associated with inflammation (tendinitis) and calcification of tendons at their attachments points to bone. This can lead to the formation of bone spurs, such as heel spurs. In fact, heel spurs are common among individuals with DISH. DISH has also been called Forestier’s disease.

How common is diffuse idiopathic skeletal hyperostosis?

DISH is more common in people over 50 and in men. Please discuss with your doctor for further information.


What are the symptoms of diffuse idiopathic skeletal hyperostosis?

The common symptoms of diffuse idiopathic skeletal hyperostosis are:

  • Stiffness may be most noticeable in the morning.
  • You may feel pain in your back or in other affected areas, such as your shoulder, elbow, knee or heel.
  • Loss of range of motion. You may notice this most when stretching side to side.
  • Difficulty swallowing or a hoarse voice. You may experience these if you have DISH in your neck.
  • You might have no signs or symptoms with DISH. For those who have signs and symptoms, the upper portion of the back (thoracic spine) is most commonly affected.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes diffuse idiopathic skeletal hyperostosis?

Diffuse idiopathic skeletal hyperostosis (DISH) is caused by the build up of calcium salts in the tendons and ligaments (calcification) and abnormal new bone growth (ossification and hyperostosis), but the reason this happens is not understood despite a lot of research. Medical researchers believe the bone formation that is unique to DISH is caused by abnormal growth and activity of bone forming cells (osteoblasts) in the area where tendons and ligaments attach to bone (enthesis). Possible causes of the this bone growth include:

  • Mechanical factors, such as repetitive lifting and moving of heavy objects
  • Dietary factors, such as long term exposure to high amounts of Vitamin A
  • Medications, such as long term use of synthetic vitamin A products or retinoids, most often used to treat severe acne
  • Genetic factors, such as a genetic predisposition
  • Metabolic conditions, such as diabetes mellitus, acromegaly, and obesity
  • Abnormalities of fat derived hormones (possibly leptin) and growth hormones

However, even when an increased risk due to a factor is consistently seen in studies, no one factor has been found to cause DISH by itself. Medical researchers therefore believe DISH is caused by several of these factors working together to cause the abnormal bone growth.

Risk factors

What increases my risk for diffuse idiopathic skeletal hyperostosis?

There are many risk factors for diffuse idiopathic skeletal hyperostosis, such as:

  • Men are more likely to develop DISH.
  • Older age. DISH is most common in older adults, especially in people older than 50.
  • Diabetes and other conditions. People with type 2 diabetes may be more likely to develop DISH than are those who don’t have diabetes. Other conditions that may raise insulin levels in your body may also increase your risk, including hyperinsulinemia, prediabetes and obesity.
  • Certain medications. Long-term use of medications called retinoids, such as isotretinoin (Amnesteem, Claravis, others), which are similar to vitamin A, can increase your risk of diffuse idiopathic skeletal hyperostosis. It isn’t clear whether high intake of vitamin A increases your risk, however.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is diffuse idiopathic skeletal hyperostosis diagnosed?

A diagnosis of diffuse idiopathic skeletal hyperostosis (DISH) is often suspected by the signs and symptoms a person has. X-rays can confirm the diagnosis. In some cases, a computed tomography (CT scan) and/or magnetic resonance imaging (MRI) may also be ordered to rule out other diseases that cause the same symptoms.  All three types of imaging studies may be used to see which other areas of the skeleton are affected by DISH.

How is diffuse idiopathic skeletal hyperostosis treated?

Treatment of diffuse idiopathic skeletal hyperostosis (DISH) is focused on the signs and symptoms present in each person. For example, pain caused by DISH is often treated with pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). Severe pain may be treated with corticosteroid injections. Muscle relaxants may also be helpful.

Physical therapy and/or exercise may reduce the stiffness associated with DISH and can help increase range of motion in the joints.

Even though few studies have focused on indications for surgery, it is generally accepted that surgery is indicated for people with severe symptoms (such as airway obstruction and/or dysphagia) in whom medication and therapy approaches have failed.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage diffuse idiopathic skeletal hyperostosis?

The following lifestyles and home remedies might help you cope with diffuse idiopathic skeletal hyperostosis:

  • Exercise regularly. Regular aerobic exercise, such as walking or swimming, can increase your endurance, keep your body more nimble and help you cope with DISH. Talk with your doctor before starting an exercise program.
  • Achieve and maintain a desirable weight. Since obesity is associated with DISH, losing weight may help keep the disease from progressing and lower your risk of complications.
  • Apply heat. Use a heating pad on areas of your body that are affected by diffuse idiopathic skeletal hyperostosis to reduce pain. Set the heating pad at a low setting to reduce the risk of burns.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.


Review Date: October 9, 2017 | Last Modified: October 10, 2017

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