Diffuse Idiopathic Skeletal Hyperostosis

National Organization for Rare Disorders, Inc.

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It is possible that the main title of the report Diffuse Idiopathic Skeletal Hyperostosis is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.


  • Diffuse Idiopathic Skeletal Hyperostosis
  • DISH
  • Spinal Diffuse Idiopathic Skeletal Hyperostosis
  • Spinal DISH
  • Vertebral Ankylosing Hyperostosis
  • Forestier's Disease

Disorder Subdivisions

  • None

General Discussion

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, affects the ligaments around the spine. Sections of the ligaments turn into bone in this disorder, which is considered to be a form of degenerative arthritis.

The conversion of ligamental tissue to bone usually extends along the sides of the vertebrae of the spine. (This may be called flowing calcification.) Also, DISH is associated with inflammation (tendinitis) and calcification of the tendons, especially at the points at which the tendon attaches to the bones. When this happens, the patient is said to have developed bone spurs, especially in the heel and ankles (heel spurs).

DISH affects three or more vertebrae that are most often located in the chest or in the spine between the chest and pelvis. It is a disorder of older patients, more often affecting men than women ages 50-60. The disorder is often found in association with diabetes, high blood pressure, heart disease and obesity.


Because bone spurs are so often associated with DISH, intermittent stiffness of the spine, especially in the evening and upon arising in the morning, is often a sign of the disorder. Many people with DISH have trouble swallowing and moving their necks or backs. Usually such signs occur when bony overgrowths place pressure on nearby nerves (nerve compression or entrapment) causing irritation. DISH progresses slowly, and calcification may take several years to complete its course.


The exact cause of diffuse idiopathic skeletal hyperostosis is unknown. Changes in cartilage may cause the bony overgrowths to occur. This may be due to aging, trauma, or wear and tear in the course of a lengthy sports career. Disorders that involve disturbances in cartilage metabolism, such as diabetes mellitus or acromegaly, or certain inherited connective tissue disorders may also lead to DISH. (For more information, choose "diabetes mellitus," "acromegaly," or "connective tissue" as your search terms in the Rare Disease Database).

Affected Populations

Diffuse idiopathic skeletal hyperostosis is a common subtype of osteoarthritis. About 19% of men older than 50 years present with DISH while only about 4% of women over the age of 50 years do so. For unknown reasons, a major ligament of the spine (posterior longitudinal) is calcified in 2% of a Japanese population while only about 0.16% of a similar Caucasian population will present with DISH in this same ligament.

DISH has been described as a phenomenon rather than a disease. Double-blind controlled studies have shown that DISH is not associated with any other pathology. Patients with DISH show no greater tendency towards arthritis, bursitis, tendinitis and back pain than do the control subjects. Patients diagnosed with DISH who have back pain show no difference in the character and duration of the pain.

Standard Therapies


The diagnostic criteria for DISH are fairly strict in order to distinguish this disorder from degenerative disc and joint disease and ankylosing spondylitis. At least the following must be present:

1. Calcification of at least four (4) contiguous vertebrae

2. Absence of disc disease and no compression of the discs

3. Vertebral joints should be mobile and free of packing pressure


Anti-inflammatory drugs, including non-steroid anti-inflammatory drugs (NSAIDS) are often prescribed. In relatively rare cases, surgery to correct deformities may be prescribed. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:




Epstein NE. Diffuse Idiopathic Skeletal Hyperostosis (Forestier Disease). In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:9-10.

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:446.

Kelley WN, Harris ED, Ruddy S, et al. Textbook of Rheumatology. 4th ed. W. B. Saunders Company. Philadelphia, PA; 1993:955.


Mader R. Diffuse idiopathic skeletal hyperostosis: a distinct clinical entity. Isr Med Assoc J. 2003;5:506-08.

Olivieri I, Salvarani C, Cantini F, et al. Ankylosing spondylitis and undifferentiated spondyloarthropathies: a clinical review and description of a disease subset with older age onset. Curr Opin Rheumatol. 2001;13:280-84.

Belanger TA, Rowe DE. Diffuse idiopathic skeletal hyperostosis: musculoskeletal manifestations. J Am Acad Orthop Surg. 2001;9:258-67.

Cammisa M, De Serio A, Guglielmi G. Diffuse idiopathic skeletal hyperostosis. Eur J Radiol. 1998;27 Suppl 1:S7-11.


Troyanovich SJ, Buettner M. A structural chiropractic approach to the management of diffuse idiopathic skeletal hyperostosis. J Manipulative Phsiol Ther. 2003;26:202-06.

Mader R. Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum. 2002;32:130-35.

Mears T. acupuncture for back pain ina patient with Forestier's disease (diffuse idiopathic skeletal hyperostosis/DISH). Acupunct Med. 2002;20:102-04.

Ozgocmen S, Kiris A, Kocakoc E, et al. Osteophyte-induced dysphagia: report of three cases. Joint Bone Spine. 2002;69:226-29.

Kiss C, Szilagyi M, Paksy A, et al. Risk factors for diffuse idiopathic skeletal hyperostosis: a case control study. Rheumatology (Oxford). 2002;41:27-30.

Coaccioli S, Fatati G, Di Cato L, et al. Diffuse idiopathic skeletal hyperostosis in diabetes mellitus

Vidal P. A paleoepidemiologic study of diffuse idiopathic skeletal hyperostosis. Joint Bone Spine. 2000;67:210-14.

Epstein NE. Simultaneous cervical diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament resulting in dysphagia or myelopathy in two geriatric North Americans. Surg Neurol. 2000;53:427-31.


McKusick VA, Ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Ankylosing Vertebral Hyperostosis with Tylosis. Entry Number; 106400: Last Edit Date; 3/11/2003.

Rothschild BM. Diffuse Idiopathic Skeletal Hyperostosis. emedicine. Last Updated: December 31, 2002. 7pp.


Nakhoda K. Greene G. Diffuse Idiopathic Skeletal Hyperostosis. emedicine. Last Updated: April 30, 2002. 9pp.


Diffuse Idiopathic Skeletal Hyperostosis (DISH). Arthritis-Symptom.com. nd. 3pp.


Shiel WC Jr. Diffuse Idiopathic Skeletal Hyperostosis ("DISH" or Forestier Disease) MedicineNet.com. Last Editorial Review: 4/30/02. 2pp.


Hyperostosis. The Encyclopedia of Medical Imaging. Volume III:1. nd. 2pp.



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