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Diseases

Genetic and Rare Diseases Information Center (GARD)

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
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

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 in which the ligaments (connective tissues that connect bones) around the spine turn into bone. Many people with this condition do not experience any symptoms. When present, the most common features are pain and stiffness of the upper back; however, other symptoms may also develop when bone spurs press on nearby organs or parts of the body. The exact underlying 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. Treatment for DISH depends on many factors including the signs and symptoms present in each person and the severity of the condition.[1][2][3]
Last updated: 5/11/2015

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

Many people affected by diffuse idiopathic skeletal hyperostosis (DISH) have no signs or symptoms of the condition. When present, symptoms vary but many include:[1][2][3]
  • Stiffness which is most noticeable in the morning
  • Pain when pressure is applied to the affected area
  • Loss of range of motion
  • Difficulty swallowing or a hoarse voice
  • Tingling, numbness, and/or weakness in the legs

The upper portion of the back (thoracic spine) is the most commonly affected site; however, people with DISH may also experience symptoms in other places such as the heels, ankles, knees, hips, shoulders, elbows, and/or hands.[1][2][3]
Last updated: 5/11/2015

What causes diffuse idiopathic skeletal hyperostosis ?

The exact underlying cause of diffuse idiopathic skeletal hyperostosis (DISH) is poorly understood. However, several factors have been associated with an increased risk of developing the condition. For example, conditions that disturb cartilage metabolism (such as diabetes mellitus, acromegaly, or certain inherited connective tissue disorders) may lead to DISH. Long-term use of medications called retinoids (such as isotretinoin) can increase the risk for DISH. Age (being older than age 50) and sex (being male) may also play a role.[3][1]
Last updated: 5/11/2015

How might diffuse idiopathic skeletal hyperostosis be treated?

Treatment of diffuse idiopathic skeletal hyperostosis (DISH) is focused on the signs and symptoms present in each person. For example, pain caused by DISH is often treated with pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). Affected people with severe pain may be treated with corticosteroid injections.[1][3]

Physical therapy and/or exercise may reduce the stiffness associated with DISH and can help increase range of motion in the joints.[1][3]

In rare cases, surgery may be necessary if severe complications develop. For example, people who experience difficulty swallowing may need surgery to remove the bone spurs in the neck.[1][3]
Last updated: 5/11/2015

What is the long-term outlook for people with diffuse idiopathic skeletal hyperostosis?

The long-term outlook (prognosis) for people with diffuse idiopathic skeletal hyperostosis (DISH) is usually considered good since it does not lead to a shortened lifespan. However, people with DISH are at risk of certain complications, such as:[1][2]
  • Disability: Loss of range of motion in the affected joint can make it difficult to use that joint.
  • Difficulty swallowing: Bone spurs associated with DISH in the neck (cervical spine) can put pressure on the esophagus, making it difficult to swallow or breath during sleep (sleep apnea).
  • Paralysis: DISH 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: 5/11/2015

References
Other Names for this Disease
  • Ankylosing vertebral hyperostosis with tylosis
  • DISH
  • DISH Forestier's disease
  • Forestier disease
  • Forestier-Rotes disease
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.