New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis)

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Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier’s disease is a common disorder among older adults. The diagnosis is based solely on radiographic abnormalities defined using the Resnick criteria. DISH is characterized by ossification of the anterior longitudinal ligament of the spine and various extraspinal ligaments. DISH often coexists with OA, but patients affected by this disorder differ from patients with primary OA in several aspects: prevalence in the general population, gender distribution, anatomic site of primary involvement, magnitude and distribution in the spine and the peripheral joints. Purpose of this review is to summarize new clinical, pathogenetic and therapeutic insights of this disease. Recent studies confirm that patients with DISH have a greater body mass index, higher serum uric acid levels and are more likely to have diabetes mellitus. In addition, DISH is most probably related to abnormal bone cell growth/activity reflecting the influence of metabolic factors that lead to new bone formation. Serum matrix Gla protein may be a marker of osteometabolic syndromes, such as DISH, that cause hyperostosis. Many recent developments of DISH are described in this review. Possible pathogenetic mechanism driving bone deposition are discussed. DISH is still recognized radiographically; no specific drug has been yet identified.