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Diffuse idiopathic skeletal hyperostosis

Last reviewed: 3 Apr 2025
Last updated: 20 Dec 2024

Summary

Definition

History and exam

Other diagnostic factors

  • spinal pain
  • stiffness of the spine
  • kyphosis
  • decreased range of motion
  • spinal fracture
  • pain, stiffness, and decreased range of motion in other joints
  • lumbar radiculopathy
  • cervical myelopathy
  • dysphagia
  • dyspnea
  • sleep apnea
  • stridor
Full details

Risk factors

  • age >50 years
  • male sex
  • obesity
  • genetic risk factors
  • metabolic disorders
Full details

Diagnostic tests

1st tests to order

  • spine x-ray
Full details

Tests to consider

  • CT spine
  • peripheral joint x-ray
  • MRI spine
  • ultrasound
  • dual-energy x-ray absorptiometry (DXA)/whole-spine vertebral fracture assessment (VFA)
  • quantitative computed tomography (QCT)
  • video swallow study
  • laryngoscopy and esophagoscopy
  • pulmonary function tests
  • C-reactive protein
  • HLA-B27
  • rheumatoid factor
  • antinuclear antibodies (ANA)
Full details

Emerging tests

  • sclerostin
  • parathyroid hormone

Treatment algorithm

ACUTE

no fracture present

fracture present

Contributors

Authors

Priyanka Iyer, MBBS, MPH

Assistant Clinical Professor, Medicine

School of Medicine

University of California, Irvine

Irvine

CA

Disclosures

PI declares that she has no competing interests.

Michael H. Weisman, MD

Adjunct Clinical Professor, Medicine - Immunology & Rheumatology

Stanford University School of Medicine

Stanford

CA

Disclosures

MHW declares that he has no competing interests.

Peer reviewers

Nicola Goodson, MB ChB, FRCP, PhD

Consultant Rheumatologist

Liverpool University Hospitals NHS Foundation Trust

Liverpool

UK

Disclosures

NG declares that she has no competing interests.

References

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Key articles

Le HV, Wick JB, Van BW, et al. Diffuse idiopathic skeletal hyperostosis of the spine: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2021 Dec 15;29(24):1044-51. Abstract

Kuperus JS, Mohamed Hoesein FAA, de Jong PA, et al. Diffuse idiopathic skeletal hyperostosis: etiology and clinical relevance. Best Pract Res Clin Rheumatol. 2020 Jun;34(3):101527.Full text  Abstract

Mader R, Verlaan JJ, Eshed I, et al. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 2017;3(1):e000472.Full text  Abstract

Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741-50. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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