Diffuse Idiopathic Skeletal Hyperostosis

Overview

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition characterized by abnormal calcification and ossification of ligaments and tendons at their attachment points to bones, primarily in the spine. It is a non-inflammatory disorder, distinct from arthritis, but may lead to stiffness and discomfort. DISH predominantly affects middle-aged and older adults and is more common in men. Early detection and management can significantly enhance the quality of life for those affected.

Introduction

DISH, also known as Forestier’s disease, is a systemic skeletal condition marked by the presence of flowing calcifications along the sides of the vertebrae in the spine. While it can involve other areas such as the pelvis, elbows, and knees, the thoracic spine is most frequently affected. The exact prevalence of DISH in India remains understudied; however, its incidence increases with age and is often associated with metabolic disorders like diabetes and obesity.

Symptoms

The symptoms of DISH can vary, with some individuals remaining asymptomatic. Common symptoms include:

– Spinal stiffness: Reduced flexibility, particularly in the mid-back region.
– Pain: Localized discomfort, especially in the affected areas, often worsening in the morning.
– Limited mobility: Difficulty in bending or turning due to calcifications.
– Difficulty swallowing (dysphagia): If calcifications compress the esophagus.
– Nerve compression: Rare cases may cause neurological symptoms like tingling or numbness.

Causes

While the exact cause of DISH remains unknown, several factors contribute to its development:

– Age: Most cases are diagnosed in individuals over 50 years old.
– Metabolic conditions: Diabetes, obesity, and hyperinsulinemia are commonly associated with DISH.
– Genetic predisposition: A family history of skeletal conditions may increase susceptibility.
– Mechanical stress: Repeated stress on tendons and ligaments may contribute to calcifications.

Treatment

Although DISH has no cure, treatment aims to manage symptoms and prevent complications. Key treatment approaches include:

1. Medications:

– Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
– Muscle relaxants for stiffness.

2. Physiotherapy:

– Stretching and strengthening exercises to improve flexibility and support mobility.
– Heat or cold therapy to alleviate pain.

3. Lifestyle modifications:

– Weight management and regular physical activity to reduce stress on the skeletal system.
– A balanced diet to support overall bone health.

4. Surgical intervention:

– Rarely required but may be necessary to address severe complications such as nerve compression or difficulty swallowing.

Prevention and Risk Factors

While DISH cannot always be prevented, certain measures can reduce the risk or delay its progression:

– Maintain a healthy weight: Reduces strain on the spine and joints.
– Control metabolic conditions: Effective management of diabetes and other metabolic disorders.
– Stay active: Regular physical activity enhances flexibility and strengthens muscles supporting the skeletal system.
– Adequate calcium and vitamin D intake: Essential for maintaining bone health.

Risk factors:

– Male gender.
– Advanced age.
– Co-existing conditions like type 2 diabetes and obesity.
– Sedentary lifestyle.

Insights from Sancheti Hospital

At Sancheti Hospital, our team of orthopedic experts employs advanced diagnostic tools and multidisciplinary approaches to manage DISH effectively. We focus on patient-centric care, offering customized physiotherapy plans and state-of-the-art treatments to enhance mobility and reduce discomfort. Our commitment to research ensures that patients receive evidence-based interventions tailored to their needs.

For individuals in India, where the rising prevalence of metabolic disorders like diabetes intersects with conditions like DISH, early diagnosis and proactive management are crucial. Our holistic approach addresses both the symptoms and underlying risk factors to ensure optimal outcomes.

References

1. Resnick D, Niwayama G. Diffuse Idiopathic Skeletal Hyperostosis (DISH): Diagnosis and Natural History. Radiology Clinics of North America.
2. Pal CP, Singh P, et al. Incidence of Skeletal Conditions in India. Journal of Orthopaedics, Trauma, and Rehabilitation.
3. Indian Diabetes Federation. Diabetes Statistics in India. Available at: [www.idf.org](http://www.idf.org)