Diffuse Idiopathic Skeletal Hyperostosis Overview

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a form of arthritis that affects soft tissues (primarily entheses and ligaments) mainly around your spine. These bands of tissue can become hardened (calcified) and form growths called bone spurs where they connect to your bones. DISH can also cause bone spurs in your hips, knees, shoulders, feet, and hands and harden bones throughout your body. 

First identified and described by Forestier and Rotes-Querol in 1950, the disease was then called "senile ankylosing hyperostosis." It has also been referred to as Forestier's disease. When researchers realized the disease could affect peripheral joints, they re-named it Diffuse Idiopathic Skeletal Hyperostosis.

This article discusses the causes, symptoms, diagnosis, and treatment of diffuse idiopathic skeletal hyperostosis.

Illustration of a human figure with axial skeleton (ribs, spine, skull, scapula) highlighted
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Symptoms Associated With DISH

People with DISH may not have symptoms. When symptoms do occur, they may include:

  • Stiffness that’s usually worse in the morning
  • Pain in the neck or upper back (cervical or thoracic spine) 
  • Limited range of motion in your back 
  • Hoarseness or trouble swallowing if nerves in the neck are compressed 
  • Tingling or numbness in your legs from compressed nerves in your lower back
  • Possible paralysis from a compressed spinal cord

Causes of Diffuse Idiopathic Skeletal Hyperostosis

DISH is relatively common, occurring in over 10% of people over age 50. DISH is also more common in males.

The cause of DISH is not known, yet certain factors appear to be associated with the condition. People with DISH often have osteoarthritis and has also been associated with:

  • Metabolic syndrome
  • Diabetes mellitus (non-insulin-dependent)
  • Obesity
  • Hyperinsulinemia
  • Dyslipidemia
  • High waist circumference ratio
  • Hypertension
  • Hyperuricemia
  • The use of retinoids (vitamin A substances)
  • A genetic predisposition, including being a member of the Pima tribe
  • Elevated levels of growth hormone
  • Elevated insulin-like growth factor

Prevalence and Statistics

The prevalence of DISH varies and is based on age, ethnicity, as well as geographic location.

DISH is more common in men than women. A 2023 study found 7.4% of females and 20.9% of males had a diagnosis of DISH in the U.S.

According to Kelley's Textbook of Rheumatology, Jews older than 40 years living in Jerusalem had a higher prevalence, while a lower prevalence was found among those in Korea (not even 9% of older people). Mild DISH was found in human remains dating back 4000 years. In human remains from the 6th to 8th centuries, the prevalence was higher in men compared to women, peaking around 3.7%.

How is DISH Diagnosed?

DISH is diagnosed through a combination of a thorough physical exam and imaging tests, such as:

Signs of calcification and ossification in specific areas of the spine and/or other areas of the body as well as hardened connective tissues between bones and tendons or ligaments will be present on imaging studies.

How Is DISH Treated?

There is no cure for DISH, but certain treatments can relieve symptoms, slow the progression of the disease, bring metabolic disorders under control, and prevent complications. Treatment may include:

  • Exercise and physical therapy:  to improve back pain, stiffness, and range of motion. Swimming is especially beneficial because it provides a full-body workout without the risk of injury.
  • Heat: to help relieve early-morning pain and stiffness. 
  • Weight and blood sugar control: DISH is often associated with obesity and diabetes, so keeping weight and blood sugar in a healthy range is important.
  • Orthotics (special shoe inserts): to make walking easier if you have bone spurs on your heels. 
  • Pain relievers:  like acetaminophen and nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen to relieve pain. For severe pain, corticosteroid injections may be an option.
  • Surgery:  only in rare cases when bone spurs compress the spinal cord or affect swallowing.

Summary

Diffuse idiopathic skeletal hyperostosis is a form of arthritis where soft tissues around your spine and sometimes other areas of the body become calcified and form growths called bone spurs where they connect to your bones.

Although the cause of DISH is unknown, many conditions are associated with developing DISH. Imaging studies can diagnose DISH and treatment involves relieving symptoms and treating underlying conditions.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Arthritis Foundation. Diffuse idiopathic skeletal hyperostosis.

  2. Columbia University. Diffuse idiopathic skeletal hyperostosis (DISH).

  3. Mader R, Verlaan JJ, Eshed I, et al. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 2017 Jun 21;3(1):e000472. doi: 10.1136/rmdopen-2017-000472

  4. Luo TD, Varacallo M. Diffuse Idiopathic Skeletal Hyperostosis. StatPearls [Updated 2023 Aug 14].

  5. Eshed I. Imaging Characteristics of Diffuse Idiopathic Skeletal Hyperostosis: More Than Just Spinal Bony Bridges. Diagnostics (Basel). 2023 Feb 3;13(3):563. doi: 10.3390/diagnostics13030563

  6. Fournier DE, Leung AE, Battié MC, et al. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and early-phase DISH across the lifespan of an american population. Rheumatology (Oxford). 2023 Jul 22:kead362. doi: 10.1093/rheumatology/kead362

Additional Reading
  • Kelley's Textbook of Rheumatology. Ninth edition. Chapter 102. Proliferative Bone Diseases. Reuven Mader.

  • A primer on the Rheumatic Diseases. Thirteenth edition. Less Common Arthropathies. Page 480. Peter A. Merkel. M.D.
Carol Eustice

By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.