DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH)

Symptoms of Diffuse Idiopathic Skeletal Hyperostosis

DISH is often asymptomatic, especially in the early stages. However, as the condition progresses, individuals may experience symptoms such as:

• Stiffness and decreased range of motion in the spine and affected joints.
• Chronic pain, particularly in the back, neck, and shoulders.
• Difficulty swallowing or breathing occurs in severe cases where cervical spine involvement compresses the esophagus or airway.
• Nerve compression symptoms, such as weakness, numbness, or tingling, may occur if spinal nerves are affected by bony outgrowths.

Diffuse Idiopathic Skeletal Hyperostosis Diagnosis

Diagnosing DISH typically involves a combination of clinical evaluation, medical history review, and diagnostic imaging studies. X-rays are the most commonly used imaging modality and can reveal characteristic findings of DISH. These include the presence of flowing ossification along the anterior aspect of multiple contiguous vertebral bodies. Additional imaging tests, such as CT or MRI scans, will allow doctors to assess the extent of spinal involvement.  In addition, they will rule out other potential causes of symptoms.

DISH, or Diffuse Idiopathic Skeletal Hyperostosis, often goes unrecognized and underdiagnosed primarily because many individuals show no symptoms. When symptoms do appear, they’re typically very mild and can sometimes mimic less serious conditions. According to Dr. Hostin, an orthopedic surgeon at the Southwest Scoliosis and Spine Institute, the asymptomatic nature of DISH complicates diagnosis. Therefore, it isn’t until symptoms progress and become more pronounced that DISH is likely diagnosed.

Are blood tests useful in diagnosing DISH?

Blood tests are generally not helpful in diagnosing DISH.  Most laboratory values, including markers of inflammation, electrolyte levels, and growth hormone measurements, tend to stay within normal limits. Because DISH is typically identified through imaging rather than bloodwork, your physician will likely rely on X-rays, CT scans, or MRI results to confirm the diagnosis and rule out other conditions.

However, Doctors may still order blood tests to exclude other possible causes of your symptoms or to look for signs of related metabolic disorders, but they do not provide a direct diagnosis of DISH.

Risk Factors Affecting Diffuse Idiopathic Skeletal Hyperostosis

Environmental factors can influence DISH or Diffuse Idiopathic Skeletal Hyperostosis. One of the primary risks involves physical injuries, specifically those related to lifting or moving heavy objects. Individuals with DISH are particularly susceptible to back and spinal injuries that can exacerbate their condition.

Another significant risk is experiencing trips and falls. These events are not only common in everyday life but pose a greater threat to those with compromised spinal health. Such accidents can lead to severe complications and prolonged recovery times for individuals with DISH.

To mitigate these risks, affected individuals must practice safe lifting techniques.  They need to ensure their living and working environments are free from tripping hazards.  And of course, seek regular medical advice to manage their condition effectively.

Several other factors may increase the risk of developing DISH, including:

• Advancing age, as DISH primarily affects individuals over 50 years old.
• The male gender as men are more commonly affected than women.
• Obesity and metabolic syndrome are linked to abnormal glucose metabolism and insulin resistance.
• Certain medical conditions, such as diabetes mellitus, hyperinsulinemia, and hyperlipidemia, may also predispose individuals to DISH.

Can Medication Influence the Development of DISH?

Yes, certain medications may play a role in the development of Diffuse Idiopathic Skeletal Hyperostosis (DISH). For instance, the use of acne medication like isotretinoin has been linked to this condition. Medicines that contain isotretinoin are commonly used treatments that might contribute to the onset of DISH. If you’re using these or similar medications and have concerns about potential side effects, it’s crucial to discuss them with your healthcare provider.

When it comes to managing the DISH symptoms, such as fluctuating pain and stiffness, medication can play a significant role. While many people find relief through gentle exercise and non-medical therapies, there are times when doctors will recommend medications. Your doctor might suggest:

• Acetaminophen for pain management
• Non-steroidal anti-inflammatory drugs (NSAIDs), though these should only be taken if your doctor determines they are safe for you
• Local steroid injections for areas with severe discomfort

It’s important not to start or change any medication without consulting your physician. Pharmacists are a valuable resource, working with your doctor to ensure any treatment plan is tailored to your specific needs. Always seek professional advice before making any decisions about medication, as a team approach provides the safest and most effective path to managing DISH.

Non-Surgical and Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis

Treatment for DISH aims to manage symptoms, improve mobility, and prevent complications. Non-surgical approaches may include:

• Physical therapy to improve flexibility, strength, and posture.
• Pain management with over-the-counter or prescription medications.
• Lifestyle modifications, such as maintaining a healthy weight and avoiding activities that exacerbate symptoms.

As DISH progresses, more severe symptoms may develop if bony growths begin to impact nearby tissues. For example, compression of the esophagus can lead to difficulty swallowing, while pressure on the upper airway (pharynx and larynx) may cause hoarseness, stridor (noisy breathing), or even sleep apnea and accidental inhalation of saliva (aspiration).

Although rare, some individuals may also experience abnormal sensations, loss of muscle strength in the arms or legs, or repeated bouts of joint pain resembling tendonitis—especially if bony overgrowths affect the tendons and ligaments. If these symptoms occur, it’s important to seek prompt medical evaluation, as they may signal nerve involvement or more advanced disease.

In cases where conservative measures fail to provide relief or severe complications arise, doctors will recommend surgery. Surgical options may include decompression procedures to alleviate nerve compression or spinal fusion to stabilize the spine and prevent further progression of the disease.

How Heat Therapy and Orthotics Support Symptom Relief

For individuals managing DISH, simple at-home strategies can make a meaningful impact. Two options—heat therapy and orthotics—are particularly beneficial for easing discomfort and supporting daily function.

Heat therapy can help loosen stiff muscles and joints that often accompany DISH. Applying a heating pad or warm compress for short intervals (generally using a “10 minutes on, 10 minutes off, then back on” method) promotes blood flow and reduces tightness, making movement less painful and morning stiffness less noticeable. Always use caution to avoid burns, and discuss the best approach with your healthcare provider.

Orthotics offer added support, especially when foot or ankle tendons are affected. By distributing pressure more evenly and supporting proper alignment, custom shoe inserts or braces can help relieve foot and lower limb pain. This improvement in stability can make walking and standing safer and more comfortable—particularly valuable if mobility is already a challenge.

Combining these simple tools with regular physical therapy, gentle exercise, and guidance from your doctor can help you better manage DISH and maintain your quality of life.

Physical Therapy Recommendations

Physical therapy plays a crucial role in managing DISH by improving flexibility, strength, and posture. A physical therapist can design a customized exercise program to target specific areas of stiffness or weakness.  In addition, the therapist can teach the patient techniques to improve mobility and reduce pain. Stretching exercises, low-impact aerobic activities, and core strengthening exercises are commonly prescribed to individuals with DISH.

How Can Occupational Therapy Help People with DISH?

Occupational therapy offers valuable support for individuals living with Diffuse Idiopathic Skeletal Hyperostosis (DISH). An occupational therapist (OT) works closely with you to address the practical challenges that DISH presents in daily life.

The OT begins by assessing your daily routines and identifying tasks or activities that may cause pain or increased strain on your spine and joints. Through this evaluation, they recommend practical changes—such as modifying your home setup, rearranging your workspace, or adapting the way you perform certain activities—to minimize discomfort and help preserve your independence.

Additionally, occupational therapists can introduce assistive devices, like grabbers or supportive cushions, that make it easier to move about or complete daily activities with less pain. They’ll also coach you on safer body mechanics and strategies to manage fatigue, so you can continue engaging in your favorite hobbies, work, and social activities.

The overall goal is to empower you to stay active and comfortable while protecting your back and joints from further stress or injury. By focusing on adaptive skills and ergonomic solutions, occupational therapy enables you to enjoy a fuller, more independent life—even while managing the effects of DISH.

DISH Complications

Complications of DISH may include:

• Spinal stenosis resulting from the compression of spinal nerves or the spinal cord by bony outgrowths.
• Fractures or dislocations of affected vertebrae due to the increased stiffness and reduced flexibility of the spine.
• Difficulty swallowing or breathing in cases of cervical spine involvement, which may require surgery to alleviate compression of the esophagus or airway.

Prevention Actions

While the exact cause of DISH is unknown, several preventive measures may help reduce the risk of developing the condition or alleviate symptoms:

• Maintaining a healthy weight and adopting a balanced diet to reduce the risk of metabolic abnormalities. Weight loss plays a crucial role in preventing Diffuse Idiopathic Skeletal Hyperostosis (DISH). Shedding excess pounds can mitigate the occurrence of conditions that are often linked with DISH. By maintaining a healthy weight, you not only reduce the strain on your skeletal system but also improve your overall metabolic health. This preventive approach helps you manage or even avert the development of DISH and its associated complications.
• Engaging in regular physical activity promotes flexibility, strength, and overall musculoskeletal health.
• Practicing good posture and body mechanics to reduce strain on the spine and joints.
• Avoiding tobacco use and excessive alcohol consumption, as these habits may exacerbate inflammation and contribute to bone health issues.

What Can Cause a Serious Fracture in Someone With DISH

Even a minor impact can cause a serious fracture in someone with Diffuse Idiopathic Skeletal Hyperostosis (DISH). This condition leads to the fusion of the spine, which makes it less flexible. As a result, any low-energy trauma or small fall can focus intense force on a specific part of the spine, leading to a significant fracture.

Related Conditions

DISH shares some similarities with other musculoskeletal conditions, such as ankylosing spondylitis and osteoarthritis. However, DISH is characterized by distinct radiographic features, including the presence of flowing ossification along the anterior aspect of vertebral bodies.

Unlike other types of arthritis, DISH does not primarily involve inflammation. Instead, it is marked by hardening (calcification) of ligaments and connective tissues, most commonly in the spine. This calcification leads to the formation of “bony bridges” between the vertebrae. This can significantly reduce spinal flexibility and contribute to symptoms like stiffness and pain.

While many musculoskeletal conditions affect the joints or involve inflammatory processes, DISH stands apart due to this unique pattern of ligamentous calcification and the absence of significant joint or disc space narrowing. Understanding these differences is important, as it helps guide both diagnosis and management, distinguishing DISH from other spinal disorders that may require different treatment approaches.

Living with the Condition

Living with DISH can present challenges, particularly in managing chronic pain and stiffness. However, with appropriate treatment and lifestyle modifications, many individuals with DISH can maintain an active and fulfilling life. Regular exercise, healthy eating habits, and proper body mechanics can help manage symptoms and improve overall quality of life.

Long-Term Benefits of Diffuse Idiopathic Skeletal Hyperostosis Treatment

The long-term benefits of treating DISH include:

• Improved mobility and flexibility allow individuals to engage in daily activities with greater ease.
• Reduced pain and discomfort, enhancing the overall quality of life and well-being.
• Prevention of complications, such as spinal stenosis or fractures, which can lead to more severe symptoms and functional limitations.

Why Choose the Southwest Scoliosis and Spine Institute

The Southwest Scoliosis and Spine Institute, led by our fellowship-trained, board-certified expert Diffuse Idiopathic Skeletal Hyperostosis Doctors, Richard Hostin, MD, Devesh Ramnath, MD, and Ishaq Syed, MD, offers comprehensive care for individuals with spinal conditions, including DISH. With offices in Dallas, Plano, and Frisco, Texas, the institute provides state-of-the-art diagnostic and treatment options tailored to each patient’s unique needs.

The team of highly experienced spine specialists utilizes advanced techniques and technologies to deliver optimal outcomes and improve patients’ quality of life. From conservative management strategies to advanced surgery, the Southwest Scoliosis and Spine Institute offers compassionate care and personalized treatment plans to help individuals with DISH regain mobility, alleviate pain, and achieve long-term relief.

In conclusion

DISH refers to a non-inflammatory skeletal condition characterized by excessive bone growth along the spine and other parts of the body. While often asymptomatic, DISH can lead to pain, stiffness, and mobility issues in some cases. Treatment options include non-surgical approaches such as physical therapy and pain management, as well as surgery for severe cases. Choosing a specialized spine institute like the Southwest Scoliosis and Spine Institute can provide individuals with access to comprehensive care and advanced treatment options to effectively manage DISH and improve their quality of life.

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Citation: Arthritis Foundation – Diffuse Idiopathic Skeletal Hyperostosis

The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.