Diffuse Idiopathic Skeletal Hyperostosis (DISH or Forestier's Disease)

Medically Reviewed on 4/18/2023

What is diffuse idiopathic skeletal hyperostosis (DISH)?

DISH causes dull pain and stiffness in the lower and upper back.
DISH causes dull pain and stiffness in the lower and upper back.

Diffuse idiopathic skeletal hyperostosis (DISH) is considered a form of degenerative arthritis or osteoarthritis. However, DISH is characterized by unique, flowing calcification along the sides of the contiguous vertebrae of the spine. And, very unlike typical degenerative arthritis, it's also commonly associated with inflammation (tendinitis) and calcification of tendons at their attachments points to the bone. This can lead to the formation of bone spurs, such as heel spurs. In fact, heel spurs are common among individuals with DISH. DISH has also been called Forestier's disease.

What causes diffuse idiopathic skeletal hyperostosis?

It is not known what causes DISH. DISH is associated with metabolic syndrome and is more frequent in people with diabetes mellitus.

What are symptoms of diffuse idiopathic skeletal hyperostosis?

Symptoms of DISH include intermittent pains in the areas of the bony changes of the spine and inflamed tendons. Stiffness and dull pain, particularly in the upper and lower back, are common. Sometimes pains in these areas can be sharp with certain body movements, such as twisting or bending over.

DISH is only slowly progressive. Calcifications between the vertebrae occur over many years. This calcification can lead to the limitation of motion of the involved areas of the spine.

Diagnosis of diffuse idiopathic skeletal hyperostosis

DISH is diagnosed when the characteristic flowing calcifications are detected with images of the spine, such as in plain film X-ray methods.

What is the treatment for diffuse idiopathic skeletal hyperostosis?

Because areas of the spine and tendons can become inflamed, anti-inflammatory medications (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), can be helpful in both relieving pain and inflammation of DISH. It is hoped that by minimizing inflammation in these areas, further calcification of tendons and ligaments of the spine leading to calcific bony outgrowths (osteophytes) will be prevented.

What is the prognosis for diffuse idiopathic skeletal hyperostosis?

DISH often causes no symptoms, and the long-term outlook is generally good. DISH can lead to a limitation of the range of motion of the spine. There is no associated threat to any internal organs with this disorder. Rarely, large bone spurs can form in front of the spinal vertebrae of the neck. These spurs occasionally interfere with the passage of food through the upper esophagus (swallowing tube).

Is it possible to prevent diffuse idiopathic skeletal hyperostosis?

There is no prevention of DISH.


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Medically Reviewed on 4/18/2023
Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.