The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands

Abstract

Objective: In diffuse idiopathic skeletal hyperostosis (DISH), spinal ankylosis may occur due to longitudinal ligament ossification. DISH can lead to back pain, impaired mobility, and displaced fractures after minor trauma. Its etiology is unknown, but is associated with obesity and type 2 diabetes mellitus. We investigated the prevalence of DISH in an outpatient population in the Netherlands.

Methods: Chest radiographs of 501 patients (age > 50 yrs) referred to our institution by general practitioners for non-spine-related conditions were reviewed. DISH was established according to defined criteria; 3-level involvement was defined as pre-stage DISH. Logistic regression analysis was used to investigate the influence of age and sex on the prevalence of DISH.

Results: The overall prevalence of DISH was 17.0% (95% CI 13.7-20.3). A significant increase with age was observed (odds ratio 1.03, 95% CI 1.01-1.05; p = 0.006). The odds ratio of male sex was 1.85 (95% CI 1.20-2.86; p = 0.006). The individual predicted probability of developing DISH was 32.1% in 80-year-old men and 16.9% in women of the same age. Pre-stage DISH was found in 4.6% of the individuals and was more frequent in women.

Conclusion: The prevalence of DISH in this outpatient cohort was 17.0%, which is high compared to recent reports. Age and sex were significantly related to the presence of DISH, suggesting that men and older individuals have a higher probability of developing DISH.