Diffuse Idiopathic Skeletal Hyperostosis and Its Relation to Back Pain Among Older Men: The MrOS Study

Abstract

Objectives-To estimate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a cross sectional study of elderly men age 65-100 years, and to examine back and neck pain as possible correlates of DISH.Methods-DISH was defined using Resnick's criteria and scored according to Mata on lateral spine radiographs of 298 randomly selected participants from the MrOS Study. Standardized selfreported questionnaires were used to assess the frequency and severity of back and neck pain, and the relation of these to DISH status was estimated with Chi-square tests, as well as prevalence ratios (PR) and 95% confidence intervals using log-binomial regression models.Results-DISH was observed in 126 older men (42%), increased with age (30%, 39%, 48%, and 56% for ages 65-69, 70-74, 75-79, and ≥80 respectively), and was positively associated with body mass index (BMI)(p=0.04) and blood pressure (p=0.02). Significantly less back pain in the past 12 months was reported among men with DISH as compared to men without (59% vs. 71%, p=0.03) which remained after adjustment for age, BMI and blood pressure (PR=0.73, 95% CI=0.57-0.95). Back pain severity (p=0.07) and frequency (P=0.06) were also less frequent among men with DISH compared to men without; while reported neck pain was similar between groups (P=0.39). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Among

Dorsal vertebral column abnormalities in dogs with disseminated idiopathic skeletal hyperostosis (DISH)

“…Although DISH is relative commonly encountered in humans (Holton and others 2011), only a few reports have discussed its presence in dogs (Kranenburg and others 2011, Ortega and others 2012). A recent radiographic study has estimated the prevalence of DISH to be 3.8 per cent in clinically normal dogs with a significantly higher prevalence in older animals, males and the Boxer breed (Kranenburg and others 2010).…”

“…Reported clinical signs of DISH in dogs include stiffness, and axial and appendicular skeletal pain (Woodard and others 1985, Morgan and Stavenborn 1991, Kranenburg and others 2011). Several human and veterinary studies have suggested that spinal stiffness associated with DISH could biomechanically predispose to adjacent segment disease, vertebral canal stenosis, vertebral subluxations and spinal fractures after minor trauma (Pascal-Mousselard and others 2006, Chi and others 2008, Kawabori and others 2009, Westerveld and others 2009, Koizumi and others 2010, Holton and others 2011, Ortega and others 2012, Kornmayer and others 2013). It has been postulated that DISH in dogs may result in biomechanical changes comparable to spinal fusion (Ortega and others 2012).…”

Chiropractic management of a veteran with lower back pain associated with diffuse idiopathic skeletal hypertrophy and degenerative disk disease

“…Another possibility is that the ligament ossification is an aberrant biologic response in attempting to establish stability. 16 This could explain why Holton et al 32 found that self-reported back pain was lower in older men with DISH as compared with those without DISH. Three different scholarly works concluded that DISH may be a finding without clinical relevance and not a satisfactory explanation for lower back pain.…”

Fatal complication of diffuse idiopathic skeletal hyperostosis (DISH): report of a case

“…Elderly men are most commonly affected. 2 It is uncommon in patients younger than 50 years and rare in patients younger than 40 years. Although Forestier's disease is a symptomatic in general, previous research was reported dysphagia, dyspnea and dysphonia all together only in rare cases.…”