Diffuse idiopathic skeletal hyperostosis: A review of current literature

• Author Details:   
• Swaminathan Ramasubramanian ^*
• Sangeetha Balaji

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Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a non-inflammatory skeletal disease characterized by exuberant ossification at entheses, particularly affecting the anterior longitudinal ligament of the spine and multiple peripheral sites. This review synthesizes current literature on the epidemiology, pathogenesis, clinical spectrum, diagnostic criteria, and management strategies for DISH. Epidemiological data indicate a prevalence of approximately 12% in the general population, increasing with age and exhibiting a male predominance, although metabolic comorbidities may modify sex-related risk. The pathophysiology remains incompletely defined but implicates metabolic syndrome components, growth factor dysregulation, genetic predisposition, and local vascular alterations in aberrant bone formation. Clinically, DISH ranges from asymptomatic radiographic findings to severe manifestations including back pain, stiffness, dysphagia, respiratory compromise, neurological deficits, and increased fracture risk. Radiographs remain the primary diagnostic modality, supplemented by CT and MRI for early detection and differential diagnosis from conditions such as ankylosing spondylitis. Management focuses on symptom relief through pharmacologic agents, physical therapy, and lifestyle modifications, with surgery reserved for complications like dysphagia or unstable fractures. Significant gaps persist regarding early disease biomarkers, mechanistic pathways, and targeted therapies. Future research should emphasize longitudinal studies, molecular investigations, and randomized trials to inform evidence-based interventions. By consolidating findings on genetic loci such as RUNX2, BMP, and Wnt pathway genes, this review highlights potential molecular targets. Additionally, it underscores the importance of integrated care addressing metabolic syndrome features. Emerging technologies, such as ‘clinical trials in a dish’, offer promise for personalized treatment development, refine therapies.

Keywords: DISH, Enthesopathy, Metabolic syndrome, Osteogenesis, Imaging, Management