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Genetic and Rare Diseases Information Center (GARD)

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Diffuse idiopathic skeletal hyperostosis


* Not a rare disease
Other Names for this Disease
  • Ankylosing vertebral hyperostosis with tylosis
  • DISH
  • DISH Forestier's disease
  • Forestier disease
  • Forestier-Rotes disease
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Your Question

I have diffuse idiopathic skeletal hyperostosis (DISH), a condition also known as Forestier disease. I would like to learn more about this disease, including how it is treated. 

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is diffuse idiopathic skeletal hyperostosis (DISH)? 

Diffuse idiopathic skeletal hyperostosis (DISH) is a form of degenerative arthritis characterized by excessive bone growth along the sides of the vertebrae of the spine.[1] Also known as Forestier disease, DISH causes stiffness in the upper back, and may also affect the neck and lower back.[2] Some people experience DISH-associated inflammation and calcification (bone growth) at other areas of the body where tendons and ligaments attach to bone, such as at the heels, ankles, hips, shoulders, elbows, knees and hands.[1][2] The exact cause of DISH remains unknown, although risk factors such as age, gender, long-term use of certain medications and chronic health conditions have been identified.[1][2]
Last updated: 11/17/2013

What are the signs and symptoms of diffuse idiopathic skeletal hyperostosis (DISH)?

Diffuse idiopathic skeletal hyperostosis often causes no symptoms, though stiffness and pain along affected ligaments can occur. The signs and symptoms experienced by individuals with diffuse idiopathic skeletal hyperostosis depend on which part of the body is affected. The upper portion of the back (thoracic spine) is most commonly affected. Some people experience diffuse idiopathic skeletal hyperostosis beyond the spine in areas such as their heels, ankles, knees, hips, shoulders, elbows and hands.[2] The calcification which occurs in this condition can lead to bone spurs.[1] Other signs and symptoms may include:[2]
  • Stiffness which is most noticeable in the morning.
  • Pain when pressure is applied to the affected area. 
  • Loss of lateral range of motion. 
  • Difficulty swallowing or a hoarse voice, particularly if the cervical spine is affected.
Last updated: 7/13/2011

What causes diffuse idiopathic skeletal hyperostosis (DISH)?

The cause of diffuse idiopathic skeletal hyperostosis remains unknown, but several risk factors are implicated on the basis of its frequent association with various metabolic conditions, including hyperinsulinemia with or without diabetes mellitus (perhaps due to insulin or insulin-like growth factors that promote new bone growth), obesity, hyperuricemia, dyslipidemia, hypertension, and the prolonged use of isoretinol. Age (being older than age 50) and sex (being male) also play a role.[1][2]
Last updated: 11/14/2013

How might diffuse idiopathic skeletal hyperostosis (DISH) be treated?

While there's no cure for diffuse idiopathic skeletal hyperostosis, there are options available to help reduce the pain and manage the stiffness which may be associated with this condition.[2]

Treatment for pain caused by diffuse idiopathic skeletal hyperostosis is similar to that of other joint ailments. Pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) may be of some benefit. More severe pain can be treated with corticosteroid injections.[1][2]
Staying active and getting regular exercise may help to reduce the symptoms of diffuse idiopathic skeletal hyperostosis. Walking, swimming, stretching and yoga are good exercises for managing the symptoms of diffuse idiopathic skeletal hyperostosis.[1][2] 

Physical therapy can reduce the stiffness associated with diffuse idiopathic skeletal hyperostosis. Exercises may also increase range of motion in the joints.[1][2]

Surgery may be required in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who experience difficulty swallowing due to large bone spurs in the neck may need surgery to remove the bone spurs. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.[2]

Last updated: 7/13/2011

What is the prognosis for individuals with diffuse idiopathic skeletal hyperostosis (DISH)?

People with diffuse idiopathic skeletal hyperostosis are at risk of certain complications, such as:[2]
  • Disability. Loss of range of motion in the affected joint can make it difficult to use that joint. For instance, diffuse idiopathic skeletal hyperostosis in the shoulder can make it difficult and painful to use the arm.
  • Difficulty swallowing. Bone spurs associated with diffuse idiopathic skeletal hyperostosis in the neck (cervical spine) can put pressure on the esophagus, making it difficult to swallow. The pressure from bone spurs can also cause a hoarse voice or difficulty breathing during sleep (sleep apnea). In rare circumstances this can become serious and may require surgery to remove the bone spurs.
  • Paralysis. Diffuse idiopathic skeletal hyperostosis that affects the ligament running up the outside of the spine (posterior longitudinal ligament) can put pressure on the spinal cord. Spinal cord compression may result in a loss of feeling and paralysis.
Last updated: 11/10/2010