Diffuse idiopathic skeletal hyperostosis in the Medici, Grand Dukes of Florence (XVI century)

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH) is a common systemic disorder characterised by the ossification of the anterior longitudinal spinal ligament involving at least three contiguous vertebrae and by diffuse extraspinal enthesopathies. The condition is associated with the male sex and with advanced age; its aetiology is uncertain, but seems to be related to obesity and diabetes. The most recent studies in archaeological series demonstrated a relation between high social status and the incidence of DISH. The present study examines two cases of DISH found amongst the members of the Medici family buried in the Basilica of San Lorenzo in Florence. The skeletons of the Grand Dukes Cosimo I (1519-1574) and his son Ferdinand I (1549-1609) showed the typical features of the condition. This result is related to the obesity of the Grand Dukes, attested by the written and artistic sources, and to the protein-based alimentation demonstrated by a paleonutritional study, thus furnishing further evidence to the significance of DISH as a life style.

Paleopathology in the Piraino mummies as illustrated by X-rays

“…Paleopathological studies indicate a link between high social status and the risk of developing DISH. Examples include two members of the Medici family of Florence, Prince Luigi Carafa di Stigliano, the bishop of Alghero, Eliseo Giordano, as well as three cases from the aforementioned Savoca crypt (Fornaciari, 2006;Fornaciari and Lunardini, 2003;Fornaciari et al, 2009;Giuffra et al, 2010). The cases of DISH reported in this article seem to confirm the association between the onset of this condition and elite status, which would have implied privileged eating habits.…”

The ossification diathesis in the Medici family: DISH and other features

“…More recent studies have identiWed a familial syndrome consisting of cutaneous symptoms, peripheral arthropathy and spinal ankylosis in the primogenito branch of the family and found evidence of diVuse idiopathic skeletal hyperostosis (DISH) in two sixteenth century members of the secondogenito branch [10][11][12]. The present study extends these Wndings by providing a further speciWcation of the ossiWcation diathesis in the familial syndrome of the primogenito branch of the Medici family to determine whether DISH was a component of this syndrome.…”

Spinal hyperostosis in humans and companion animals

“…DISH is not a typical disorder of recent history. Signs of DISH have been found, for example, in the skeletons of the remains of Rhamses II (1302-1213 BC in Egypt), in several members from the Italian sixteenth century D'Medici family and in ancient clergymen in the Netherlands (Bjorkengren et al 1987;Rothschild 1987;Chhem et al 2004;Verlaan et al 2007;Giuffra et al 2010). DISH was first comprehensively described by Forestier and Rotes-Querol in 1950.…”