Diffuse Idiopathic Skeletal Hyperostosis (DISH) Clinical Presentation

Updated: Jun 22, 2020
  • Author: Bruce M Rothschild, MD; Chief Editor: Jeffrey D Thomson, MD  more...
  • Print


Diffuse idiopathic skeletal hyperostosis (DISH) is often an asymptomatic phenomenon that is discovered incidentally on imaging studies taken for some other reason. Reported manifestations, which may result from neuropathy or from physical impingement by bony overgrowth, have included the following [1] :

  • Polyarticular pain
  • Neck/thoracic/lumbar/extremity pain
  • Acute monoarticular synovitis
  • Limited range of spinal motion
  • Dysphagia [29]
  • Increased susceptibility to unstable spinal fractures
  • Airway obstruction of varying degrees


If vertebral fusion is quite extensive, reduction in range of spinal motion occurs. [30] Because uniform vertebral involvement is extremely rare, no relatable findings exist.



Causes are unknown. Diffuse idiopathic skeletal hyperostosis (DISH) is simply a tendency toward calcification of entheses.

Epidemiologic studies have identified a range of risk factors for DISH, with higher rates seen with age over 50 years, in men compared with women, and in the white population compared with black, Asian, and Native-American populations. [4] Additional risk factors include the following [31] :

  • Obesity
  • Hypertension
  • Metabolic syndrome
  • Type 2 diabetes mellitus
  • Hyperuricemia

Lantsman et al reported that abdominal computed tomography showed significantly more visceral adipose tissue, as well as a significantly higher ratio of visceral to subcutaneous adipose tissue, in 43 patients with DISH as compared with 42 controls. These authors note that visceral adipose tissue is by itself associated with bone proliferation, and suggest that it is potentially a pathogenic pathway for enthesopathic excessive bone production in DISH. [32]