May 10, 2025 • 29 mins
Could your persistent back stiffness be signaling something more significant about your overall health? Diffuse Idiopathic Skeletal Hyperostosis (DISH) might be the missing piece in your health puzzle—a condition where extra bone forms along the spine and other joints, creating flowing bridges between vertebrae while preserving disc spaces.
Despite affecting a substantial portion of the population, particularly men over 50, DISH frequently goes undiagnosed. What makes this condition particularly noteworthy isn't just its effects on bone—it's the remarkable connections to metabolic health. Our deep dive reveals the strong associations between DISH and conditions like diabetes, obesity, metabolic syndrome, and cardiovascular issues. This suggests that DISH isn't merely a bone disorder but potentially another manifestation of broader metabolic dysfunction.
Perhaps most concerning is the dramatically increased risk of spinal fractures in people with DISH. A spine stiffened by these bony bridges becomes brittle, functioning more like a single long bone than a flexible column. The result? Up to four times higher fracture risk, even from minor trauma, with a substantially greater chance of spinal cord injury. We also explore how DISH in the cervical spine can occasionally cause swallowing or breathing difficulties, and how it might impact lung function through reduced chest wall mobility.
The exact cause of DISH remains elusive—hence the "idiopathic" in its name—though we examine fascinating theories involving genetics, blood vessel patterns, and metabolic factors. While specific treatments to halt bone formation don't yet exist, understanding this condition allows for better symptom management and more comprehensive health monitoring.
If you're experiencing unexplained spinal stiffness, particularly if you have risk factors for metabolic syndrome, this episode provides crucial insights that could change your approach to bone and overall health. Visit LifeWellMD.com or call 561-210-9999 to explore how our comprehensive approach to health and longevity can help address conditions like DISH and their broader implications for your wellness.
Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Imagine this you could be walking around with a
condition affecting your bones,something that might even
increase your risk of fracturesand links to things like heart
issues, diabetes, and you mightnot even know its name.
Talking about diffuseidiopathic skeletal hyperostosis
, or DISH, it's a mouthful right.
Speaker 2 (00:21):
It really is Dish.
Speaker 1 (00:22):
It's a mouthful right , it really is.
But this deep dive is going tounpack what you need to know
about this often missedcondition and why it could be
relevant to your long-termhealth.
Speaker 2 (00:30):
Exactly.
We're taking a close look atdish today.
It's basically a conditionwhere extra bone forms in the
body.
What makes dish distinct?
Well, it's the way it oftenshows up along the spine.
You get at least three bonybridges forming along the front
and the side of the vertebrae.
Speaker 1 (00:45):
Bony bridges.
Speaker 2 (00:46):
Yeah, but it's not just the spine.
This extra bone can pop up inother places too.
Think shoulders, elbows, hips,knees, ankles, usually where
tendons and litiments attach tothe bone.
Those are called emphases.
So these bony bridges formingit almost sounds like your
body's trying to fuse itself.
Maybe In a way, yeah, but it'snot necessarily a good thing.
This extra bone, as we'llexplore understanding dish, is
(01:10):
really important.
It's linked to a higher chanceof spinal fractures for one
Right and, maybe surprisingly,it has strong connections to
things like metabolic syndrome.
Speaker 1 (01:19):
Which includes high blood pressure cholesterol
issues.
Speaker 2 (01:21):
Exactly, and potential issues with your heart
, even your breathing Wow.
And that's why we at LifeWellMDwe're an innovative clinic down
here in Florida specializing inhealth, wellness and longevity
we feel it's just so importantto bring conditions like DISH
into the light.
Speaker 1 (01:38):
Makes sense.
Speaker 2 (01:39):
We're really dedicated to helping you
understand your body's signals,you know, and take proactive
steps towards better health.
If you're curious to learn moreabout how we do things, you can
always visit us atLifeWellMDcom.
Speaker 1 (01:51):
Good to know, so let's start with that name, then
Diffuse Idiopathic SkeletalHyperostosis.
It kind of tells a story,doesn't it?
Speaker 2 (02:00):
It does.
Yeah, it's evolved quite a bitover time.
Speaker 1 (02:02):
I think it started with something more basic.
Speaker 2 (02:04):
That's right.
Initially it was often justcalled hyperostosis in the
spinal column Prettystraightforward, it's true too.
Then later it became known asForrester's disease, named after
the doctors who really broughtattention to it back in the
mid-20th century.
Okay, and the term D-SAGE, theone we use most commonly now,
that came about in the mid-70s,coined by researchers Resnick
(02:26):
and colleagues who were lookingfor a more precise description.
Speaker 1 (02:30):
And if you break down desage, each part of the name
gives you a clue.
Speaker 2 (02:35):
Exactly.
Speaker 1 (02:35):
Diffuse suggests it's widespread, not just one spot.
Idiopathic tells us.
The exact cause is still well apuzzle.
Speaker 2 (02:43):
It's all unknown, yeah.
Speaker 1 (02:44):
Skeletal points to the bones, obviously, and
hyperostosis just means extrabone growth.
Yep, same.
So DSH is all right there inthe name.
Now, how do doctors actually goabout diagnosing this?
What are they looking for?
Speaker 2 (02:56):
Well, the real breakthrough in diagnosing DSH
came back in 1976.
That was with Resnick andNuwayama.
They established radiographiccriteria things you can actually
see on an x-ray and theircriteria have really been the
cornerstone for how disease isidentified, especially in
research settings.
The first key thing is seeingflowing calcification and
(03:17):
ossification.
Speaker 1 (03:18):
Flowing Like liquid bone almost.
Speaker 2 (03:21):
Kind of yeah, along the front and side, the
anterolateral aspects of atleast four vertebrae, one after
the other in a row.
Think of it like a smooth,continuous pour of extra bone
linking these vertebrae together.
Speaker 1 (03:35):
Okay, so not like sharp individual bone spurs, but
these smoother flowingconnections, and it has to be at
least four vertebrae.
Speaker 2 (03:42):
At least four according to those original
criteria.
Then the second part is thateven with all this extra bone,
the spaces between the vertebraewhere the discs live, they
should still look relativelynormal in height.
Speaker 1 (03:53):
Right, so the discs aren't collapsing like you might
see in typical arthritis ordegeneration.
Speaker 2 (03:57):
Exactly, and they shouldn't see other big signs of
degenerative disc diseaseeither, like gas pockets in the
discs or significant hardeningof the vertebral edges.
Speaker 1 (04:07):
Okay, so the disc spaces are still holding up,
acting like spacers betweenthose bony bridges.
And the third piece.
What's the last part of thecriteria?
Speaker 2 (04:14):
The final criterion is the absence of fusion in the
small joints at the back of thespine.
Those are the epiphysial joints, or facet joints, and no
significant issues like erosion,sclerosis or fusion in the
sacroiliac joints.
That's where your spineconnects down to your pelvis.
Speaker 1 (04:32):
So these criteria really help doctors tell Dish,
apart from other things thatcause spinal stiffness or fusion
, maybe like ankle-losingspondylitis?
Speaker 2 (04:41):
Precisely.
It's like having a specificchecklist to identify dish on an
x-ray Got it?
But it's important to remember.
These criteria are developed tospot more advanced cases,
particularly in the spine.
Speaker 1 (04:52):
Right.
Speaker 2 (04:53):
They might not always pick up on earlier stages or
dish that's mainly affectingother parts of the body, like
the elbows or heels.
Speaker 1 (04:59):
Okay.
Speaker 2 (05:00):
And actually over the years researchers have proposed
lots of different diagnosticcriteria.
I think maybe around two dozenin total.
Speaker 1 (05:07):
Two dozen, Wow.
That's a lot of different waysto look at it.
What were the main differencesbetween them?
Speaker 2 (05:12):
Well, the most consistent thing across almost
all of them was that new bonebridging on the front of the
vertebrae.
That was pretty central Okay.
Speaker 1 (05:18):
But they differed in the details.
Speaker 2 (05:20):
Yeah.
Speaker 1 (05:23):
Like exactly how many vertebrae needed to be involved
?
How complete did those bonybridges have to be?
How well preserved did thediscs and other spinal joints
need to look?
Did they include bone growthand other joints?
You know peripheral andthesopathies, and even how they
looked just x-rays orincorporating newer imaging like
CT scans.
Speaker 2 (05:39):
It really sounds like the field is still maybe
fineuning the best way to defineand diagnose DSH, especially in
earlier stages or when it showsup outside the spine.
Speaker 1 (05:49):
Absolutely, and in rheumatology we often
distinguish betweenclassification criteria and
diagnostic criteria.
Speaker 2 (05:57):
What's the difference there?
Speaker 1 (05:58):
Well.
Classification criteria areusually straighter.
They're used in research tomake sure everyone's studying a
very similar, specific group ofpatients.
Diagnostic criteria are whatdoctors use day to day in the
clinic to identify the conditionin an individual patient.
Speaker 2 (06:12):
The resonant criteria are great for research because
they're very specific.
They really nail down classicDISH.
But they might be too strictsometimes for clinical use.
They could potentially excludesomeone who has DISH but maybe
also has some signs ofosteoarthritis in those facet
joints, for instance.
They might be too strictsometimes for clinical use.
They could potentially excludesomeone who has DISH but maybe
also has some signs ofosteoarthritis in those facet
joints for instance.
Speaker 1 (06:30):
So the research definition is super precise for
studying DISH alone, but in thereal world, doctors need to look
at the whole picture for eachpatient.
Okay, so we know what DISHlooks like and how it's
generally diagnosed, but what'sactually causing this extra bone
to grow?
What's going?
Speaker 2 (06:47):
on inside the body.
That is the million dollarquestion and the honest answer
is the exact cause.
The pathogenesis of DISH isstill unknown.
Speaker 1 (06:55):
Really Still idiopathic.
Speaker 2 (06:56):
Still idiopathic.
We have a lot of clues, a lotof associations we'll talk about
, but the full picture, itremains elusive.
Speaker 1 (07:03):
All right, let's dive into those clues then.
What does the extra boneactually look like up close
under a microscope?
Speaker 2 (07:08):
Microscopically.
Yeah, you see, these bonybridges are directly connected
to the existing bone of thevertebrae.
It's mostly cortical bone, thatdense outer layer.
Speaker 1 (07:16):
The hard stuff.
Speaker 2 (07:17):
The hard stuff, yeah, but there's also some
cancellous bone, the more spongyinner part, and interestingly
they've also found woven bone.
Speaker 1 (07:25):
Woven bone.
What does that mean?
Speaker 2 (07:31):
Woven bone suggests it's an active process.
It's often laid down quicklyduring periods of bone formation
or remodeling.
Think of it like the initialscaffolding that gets refined
into stronger lamellar bone overtime.
So its presence tells us thisisn't just old static bone.
There's ongoing activity.
Speaker 1 (07:43):
So it's not just a one-time event.
It's an ongoing process of boneformation and change and since
this often happens where tendonsand ligaments attach those
emphases you mentioned, whatdoes that suggest about
potential causes?
Speaker 2 (07:57):
Well, that location really points towards a complex
mix of factors probablyinfluencing the cells in those
areas.
You've got fibroblasts makingconnective tissue, chondrocytes,
which are cartilage cells plusthe collagen fibers and the
mineral matrix.
So researchers are looking at acombination of things genetic
predisposition, maybe vascularfactors, blood supply, metabolic
(08:17):
influences which seem reallykey, and even mechanical stress
on those attachment points.
Speaker 1 (08:22):
It sounds like a lot of potential players in this
game.
Now we touched on some thingsthat seem more common in people
with DISH.
What do we know about thebigger picture, the
epidemiological associations,the risk factors?
Speaker 2 (08:37):
Yeah, we've definitely identified several
strong links.
The most notable ones areincreasing age being, male
obesity, high blood pressure andhaving conditions like diabetes
and metabolic syndrome.
Speaker 1 (08:47):
Let's start with age.
That seems like a prettyconsistent factor across the
board, doesn't it?
Speaker 2 (08:51):
Absolutely.
Study after study looking athow common DISH is in different
populations shows a clear trendthe older you get, the more
likely you are to have DISH.
Speaker 1 (09:00):
Right.
Speaker 2 (09:01):
When researchers compare the average age of
people with DISH to thosewithout the DISH, group is
consistently older, and if youlook decade by decade, the
prevalence just keeps climbingsignificantly.
Speaker 1 (09:10):
So it's definitely a condition that becomes much more
common as we age.
What about gender?
You mentioned being male is afactor.
Speaker 2 (09:17):
Yes, numerous studies have found a much higher
prevalence of DISH in mencompared to women.
Some studies report ratios ashigh as like seven men for every
one woman with this dish.
Speaker 1 (09:27):
Wow, seven to one.
Speaker 2 (09:29):
Yeah, although it's worth noting some of those
studies maybe had smallernumbers or didn't fully account
for other factors, but the trendis definitely there and,
interestingly, it seems, thisgap between men and women widens
even more as people get older.
Speaker 1 (09:42):
That's quite a difference.
Okay, now let's talk aboutwheat.
There seems to be a strongconnection with obesity.
Speaker 2 (09:48):
That's right.
Pretty much every study thathas looked at the relationship
between DISH and body mass index, bmi, has found that people
with DISH tend to have a higherBMI.
And what's really telling iseven when researchers use
statistics to adjust for otherthings that might be linked like
(10:10):
age, this connection betweenDISH and higher BMI stays
significant.
Speaker 1 (10:12):
So it's not just that older people might be heavier
and have DISH.
There seems to be a more directlink.
What about high blood pressure?
Speaker 2 (10:16):
Hypertension yeah, also seen more often in people
with DISH compared to thosewithout.
Now, not every single study hasshown this to be statistically
significant, but several have,and a couple even found that the
systolic blood pressure in thetop number tends to be a bit
higher in individuals withDISH-E.
Speaker 1 (10:33):
Okay, another piece pointing towards metabolic
health.
Speaker 2 (10:35):
Yeah.
Speaker 1 (10:36):
And diabetes Diabetes mellitus?
Speaker 2 (10:38):
yes, Several studies have found that it's
significantly more common inpatients with DISH.
Others have also seen a trendtowards higher rates in the DISH
group, even if the statisticsdidn't quite reach significance
in their particular study.
Speaker 1 (10:51):
So again, it seems like DISH might travel in the
same circles as these metabolicissues.
You mentioned the broaderconcept too, metabolic syndrome.
Speaker 2 (10:58):
Yes, exactly.
When you look at metabolicsyndrome as a whole, that
cluster of risk factors.
When you look at metabolicsyndrome as a whole, that
cluster of risk factorsincreased waist size, high
triglycerides, low goodcholesterol, hdl high blood
pressure, high fasting bloodsugar.
Speaker 1 (11:11):
Right.
Speaker 2 (11:12):
There's a strong correlation with DSH.
Some of those individual partsseem more strongly linked than
others.
For example, highertriglycerides are more common
but maybe not alwaysstatistically significant on
their own.
But increased waistcircumference, higher blood
pressure and elevated fastingglucose those seem to be key
drivers of this associationbetween metabolic syndrome and
Dietsch.
Speaker 1 (11:32):
It's really starting to paint a picture, isn't it?
Dish seems to be more than justa bone thing.
It might be another signpointing towards these
underlying metabolic problems.
What about the heart and bloodvessels directly?
Speaker 2 (11:43):
That's interesting too.
While general cardiovascularevents like heart attacks or
strokes haven't consistentlybeen reported as much more
common in dish, some specificfindings are quite suggestive.
For instance, hardening of theaorta aortic sclerosis has been
found significantly more oftenin the DISH group, even after
adjusting for age and sex.
Similarly, calcium buildupcalcifications in the aorta and
(12:07):
also in the coronary arteriesthat supply the heart muscle
that's also seen more frequentlyin people with a DISH, even
when you account for things likeage, bmi and gender.
So it suggests a potential linkbetween dish and the health of
our larger blood vessels.
Speaker 1 (12:21):
That's a really important connection.
It makes you wonder if dishcould be, I don't know, an early
indicator or just part of abigger process affecting the
vascular system.
What about other parts of thebody, our lungs, for example?
Speaker 2 (12:33):
Yeah, there's an association found between dish
and lower lung volumes.
Speaker 1 (12:36):
Lower lung volumes.
How?
Speaker 2 (12:38):
Well, the thinking is that the bone growth in the
spine, especially the thoracicspine, could potentially extend
to where the ribs attach.
This could lead to a stifferrib cage less able to expand
fully.
Speaker 1 (12:51):
Right.
Speaker 2 (12:58):
And this is supported by findings of restrictive
patterns on pulmonary functiontests.
Breathing tests in with Disheshindicating a reduced capacity
to get air in, and this couldeven have implications
potentially increasing the riskof things like pneumonia,
especially in older adults witha less mobile chest wall.
Speaker 1 (13:09):
So a bone condition could actually impact how well
you breathe.
That's a connection most peopleprobably wouldn't make.
What about lifestyle factorslike smoking or drinking?
Do they play a role?
Speaker 2 (13:19):
Well, the findings on smoking and dishish have been
pretty inconsistent acrossstudies.
Some found more smokers in thegroup, others didn't, so can't
really draw a firm conclusionthere right now.
Ok, and similarly with regularalcohol consumption, after
accounting for other factors,there doesn't seem to be a
strong, clear link to dishish.
Speaker 1 (13:38):
So, unlike the clearer links with age and
metabolic factors, thoselifestyle habits don't seem to
have a consistent relationship.
Speaker 2 (13:45):
Got it Now.
There's a common idea out there, isn't there?
That dish is simply thehardening, the ossification of
that big ligament running downthe front of our spine, the AL,
the anterior longitudinalligament.
Is that what's happening?
Speaker 1 (13:59):
Ah, yes, that's a really common misunderstanding.
Yeah, but the evidence actuallypoints to something different.
Speaker 2 (14:05):
Oh.
Speaker 1 (14:05):
When researchers have looked closely, macroscopically
at spines with DISH, they foundthat the ALL, the ligament
itself, is actually stillpresent.
It's usually in its normalposition right in the midline,
at the levels where there isn'tany new bone growth, but where
the bony bridges do form,typically on the side.
The AL is often found pushedaway, displaced to the side, by
(14:27):
the new bone.
Speaker 2 (14:28):
So the new bone isn't just the ligament turning into
bone, it's actually formingalongside it and sort of
shouldering it out of the way.
Speaker 1 (14:34):
Exactly, it's forming adjacent to, and often anterior
or anterolateral to, theligament, not necessarily within
it.
That's a really importantdistinction.
It is Good to clarify that.
Now, what about genetics?
Does this run in families?
Speaker 2 (14:49):
There are definitely hints that genetics might be
involved.
Yes, we've seen reports offamilial occurrences disease
running in families, whichsuggests a possible inherited
predisposition.
Speaker 1 (15:00):
Interesting.
Speaker 2 (15:00):
Also kind of an interesting side note in the
veterinary world.
Certain dog breeds, like boxerdogs, have a significantly
higher rate of DISH than otherbreeds.
Speaker 1 (15:10):
Boxers.
Speaker 2 (15:11):
Yeah, and there's even a mouse model that
researchers use which mimicssome features of DISH In humans.
Some preliminary studies havelooked at variations, single
nucleotide polymorphisms or SNPsin specific genes like KOL6A1
and FGF2 and found potentiallinks, but this is still really
early days.
Speaker 1 (15:30):
So needs more research.
Speaker 2 (15:31):
Definitely we need larger studies like genome-wide
association studies, gwas, toreally map out the genetic
factors involved.
But the clues are there,suggesting genetics likely plays
some part.
Speaker 1 (15:41):
OK, let's circle back to where this extra bone tends
to form.
You mentioned it's often on thefront and sides and kind of
asymmetrical in the mid-back,the thoracic spine.
Why that specific pattern?
Speaker 2 (15:52):
Yeah, that pattern is fascinating and that's where
vascular factors blood vesselslikely play a role.
The thinking is that the newbone tends to form in areas that
are away from major pulsatingblood vessels like the aorta.
Speaker 1 (16:04):
Oh, the big artery.
Speaker 2 (16:05):
Exactly In the lower thoracic spine.
The aorta usually sits slightlyto the left.
And guess what?
The dish bone formation isoften more prominent on the
right side in that region.
Avoiding the pulse.
It seems so, and even moretelling in rare cases where
people have sedus inverses,where their organs are flipped.
Mirror image.
Speaker 1 (16:24):
Right heart on the right side, etc.
Speaker 2 (16:26):
Exactly In those individuals with DISH, the bony
bridges in the thoracic spinehave been observed to be
predominantly on the left side,the opposite of usual.
Speaker 1 (16:35):
Wow, that strongly suggests the aortus pulsation
influences where the bone forms,or rather where it doesn't form
.
Speaker 2 (16:42):
Precisely, it seems to avoid those strong pulsations
.
Speaker 1 (16:45):
What about the flowing nature of the bone?
Does blood flow play a rolethere too?
Speaker 2 (16:48):
Well, it's been proposed that the smaller
segmental blood vessels, theones that cross the vertebrae
around the middle of the body,might somehow contribute to that
flowing pattern, maybe byproviding nutrients or signals.
Speaker 1 (17:00):
Okay.
Speaker 2 (17:01):
And the fact that the cervical spine, the neck, which
doesn't have quite the samevascular setup, tends to have
less of that classic, smoothflowing bone formation, might
lend some support to that idea.
Speaker 1 (17:13):
Interesting.
Speaker 2 (17:14):
Also, some studies have found an increased number
and size of the little holes inthe vertebrae where blood
vessels enter the nutrientforamina, and signs of increased
blood muscle activity,hypervascularity in areas
affected by DISH A chicken oregg.
Exactly.
We're still trying to figureout if this increased blood flow
is a cause helping fuel thebone growth or if it's simply a
(17:35):
consequence of the active boneformation process right, still
more questions than answersthere.
Speaker 1 (17:40):
Now we've touched on genetics, blood vessels.
Yeah, let's still have a bitdeeper into the metabolic and
molecular theories.
We know there's that stronglink with metabolic syndrome.
How might that actuallycontribute to dish at a cellular
level?
Speaker 2 (17:53):
well, one hypothesis may be a bit simplistic is that
in people with obesity andmetabolic syndrome there might
just be sort of an excess ofenergy available systemically,
extra fuel that couldpotentially be channeled into
this extra bone formation.
Speaker 1 (18:07):
Like the body, has resources to spare for building
bone.
Speaker 2 (18:10):
Potentially, but of course that doesn't fully
explain why it targets the spineand emphases specifically.
Another related theory focusesmore on the type of fat Higher
amounts of visceral fat, the fataround the organs which is
common in metabolic syndrome.
That type of fat ismetabolically active and tends
to release more pro-inflammatorycytokines, these signaling
(18:31):
molecules.
So it's thought that thischronic low-level inflammation
associated with visceral obesitycould play a role in promoting
bone growth at susceptible sites.
Speaker 1 (18:40):
That makes sense.
Inflammation seems to beinvolved in so many chronic
conditions.
What about specific hormones ormolecules?
Anything identified as a driver?
Speaker 2 (18:49):
Yeah, some studies have found that levels of growth
hormone GH and insulin-likegrowth factor 1, igf-1, both
known to promote bone growth,tend to be higher in people with
D-ish, and researchers areactively investigating various
signaling pathways that controlbone formation, things like the
WANT pathway, nf-kappa B, bonemorphogenetic protein 2, bmp2,
(19:12):
prostaglandin I2, and thalin-1.
These are all potential playersbeing looked at.
Speaker 1 (19:17):
A lot of molecular targets.
Speaker 2 (19:18):
Yes, but again, we're still in the fairly early
stages of figuring out exactlyhow these pathways are
dysregulated or contributespecifically to dish development
.
Much more research needed there.
Speaker 1 (19:29):
It really sounds like we're chipping away at
understanding the mechanisms.
Yeah, but that precise triggerfor dish is still well
idiopathic.
Now let's shift gears a bit andtalk about why this all matters
to you, the listener.
We mentioned DISH is oftenoverlooked.
What are the real-worldclinical implications of having
DISH beyond just seeing it on anx-ray?
Speaker 2 (19:47):
Right, because DISH can often be present without
causing obvious symptoms orbecause its symptoms, like
stiffness, can mimic othercommon conditions like
osteoarthritis, it often fliesunder the radar.
However, as we've discussed,those strong links to metabolic
health, cardiovascular risks andrespiratory issues mean that
identifying it can be clinicallyvery important for managing
(20:08):
your overall health andwell-being.
Speaker 1 (20:10):
Let's talk about the symptoms people might experience
.
What kind of pain or functionallimitations are common?
Speaker 2 (20:16):
Back pain and stiffness are definitely common
complaints.
Some studies show you know70-80% of people with DISH
reporting these symptoms.
Speaker 1 (20:23):
Okay.
Speaker 2 (20:24):
But interestingly, when researchers directly
compare people with DISH tocontrol groups without it, the
findings on back pain itself canbe a bit mixed.
Some studies don't find asignificant difference in pain
levels.
Speaker 1 (20:36):
Really, that's, surprising.
Speaker 2 (20:38):
Yeah, and one study even suggested that maybe the
extra bone, by stabilizing thespine somewhat, could
potentially lead to less backpain in some individuals.
Kind of a natural fusion effectperhaps.
Speaker 1 (20:49):
Huh, a double-edged sword then less movement, but
maybe less pain sometimes, butit sounds like flexibility is
usually affected.
Speaker 2 (20:55):
Yes, difficulty bending is a commonly reported
issue and some research hasshown that things like grip
strength can be lower in peoplewith DISH, suggesting maybe a
broader impact on overallphysical function, not just the
spine.
We really need more long-termlongitudinal studies to track
how pain and flexibility changeover time in different stages of
(21:17):
DISH.
Speaker 1 (21:18):
Makes sense?
And what about when DISHaffects other joints like
shoulders, elbows, ankles?
Speaker 2 (21:23):
Yeah, when dish affects those peripheral joints,
it can certainly cause pain,stiffness and reduced range of
motion, similar toosteoarthritis, which it can
also coexist with.
Heel spurs are a commonmanifestation too, Okay,
Although, again surprisingly,some studies have even reported
less joint pain or stiffness inthe dish group compared to
controls.
But those studies might havehad limitations, so we need to
(21:44):
interpret that cautiously.
Speaker 1 (21:45):
So the clinical picture can be really varied.
What about some of the moreserious complications we touched
on earlier?
Difficulty, swallowing orbreathing problems.
Speaker 2 (21:53):
Right, because the extra bone growth in the neck,
the cervical spine, happens onthe front side.
It can sometimes physicallypress on or displace the
esophagus and the trachea.
Speaker 1 (22:03):
The swallowing tube in the windpipe.
Speaker 2 (22:05):
Exactly.
This can lead to difficultyswallowing, which we call
dysphagia, and in rarer butpotentially serious cases, it
can even cause airwayobstruction or breathing
difficulties.
Speaker 1 (22:16):
Is that common?
Speaker 2 (22:17):
Well, it's often described as rare, but a
systematic review of the medicalliterature actually found at
least 200 reported cases ofdysphagia or airway issues
linked to cervical dish, so itmight be more prevalent than we
think, perhaps under-recognizedor misattributed sometimes.
Speaker 1 (22:35):
Okay, and is there a treatment for that?
Speaker 2 (22:37):
Yes, treatment can range from conservative measures
, dietary changes, therapy, tosurgery to actually remove the
excess bone, the osteophytes,although there is a chance the
bone could grow back over time.
Speaker 1 (22:48):
That sounds like a situation where catching it
early is really important.
And then there's the othermajor concern you mentioned, the
increased risk of spinalfractures.
That sounds particularlyworrying.
Speaker 2 (22:58):
It is a significant concern.
Yes, A spine that's stiffenedby dish is less flexible.
It acts more like a single longbone rather than a series of
flexible segments.
Speaker 1 (23:09):
Right.
Speaker 2 (23:10):
So when there's trauma, even sometimes
relatively minor trauma, theenergy isn't dissipated across
multiple levels, it concentratesand the spine is much more
prone to fracture.
The risk is estimated to beabout four times higher than in
a non-dish spine.
Speaker 1 (23:24):
Four times higher.
Speaker 2 (23:25):
And, crucially, these fractures have a much higher
chance of causing spinal cordinjury, up to maybe 58% in some
reports.
Speaker 1 (23:33):
Wow, so the stiffness makes it brittle, essentially.
Speaker 2 (23:35):
In effect, yes, it leads to more unstable fracture
patterns, oftenhyperextension-type injuries,
and because the disc spaces areoften bridged by bone, the
fracture line frequently goesright through the vertebral body
itself, rather than just thedisc.
Speaker 1 (23:49):
And these fractures are generally more serious in
people with DISH.
Speaker 2 (23:53):
Yes, they tend to be more unstable mechanically.
They carry that higher risk ofneurological damage and they can
lead to more complicationsduring treatment and recovery.
Early diagnosis is absolutelycritical to prevent further
displacement of the fracture andpotential worsening of any
neurological injury.
Speaker 1 (24:10):
But diagnosis can be tricky.
Speaker 2 (24:12):
It can be.
Unfortunately, there's often adelay in diagnosing these
fractures.
Reported delays anywhere from19 to 41 percent of cases.
Speaker 1 (24:19):
Why is that?
Speaker 2 (24:20):
Well, sometimes the initial trauma might seem
minimal like a simple fall fromstanding height.
Dosing these fractures reporteddelays anywhere from 19 to 41
percent of cases.
Why is that?
Well, sometimes the initialtrauma might seem minimal, like
a simple fall from standingheight.
The patient might not have adramatic increase in their usual
baseline back pain, andstandard x-rays can be really
difficult to interpret becausethe underlying dish already
makes the spine look complex.
Speaker 1 (24:36):
So what's recommended ?
Speaker 2 (24:38):
Clinicians really need to have a high index of
suspicion for fracture in anyonewith known DGISH who
experiences trauma, even minortrauma.
Ct scans are often necessary toclearly see the fracture
pattern, and a low threshold forgetting an MRI is important too
, especially to assess thespinal cord and ligaments.
Okay, and treatment.
Treatment usually involvessurgery to stabilize the spine.
(24:59):
This has been shown to improvesurvival and neurological
outcomes.
Often posterior fixation withscrews and rods is preferred For
certain fracture types withoutneurological deficit less
invasive percutaneous techniquesmight be an option.
Speaker 1 (25:15):
So if you have DISH and you have any kind of fall or
accident, it's really crucialto get checked out thoroughly,
being aware of this higherfracture risk.
Speaker 2 (25:24):
Okay.
So, given all this, what arethe actual treatment options for
dish itself, not just thecomplications.
Speaker 1 (25:30):
That's the challenge, Because we don't yet fully
understand the underlying cause,the pathogenesis.
There's currently no specifictreatment to stop the bone from
forming or to reverse theprocess.
Speaker 2 (25:41):
Right.
Still waiting on understandingthe idiopathic part.
Speaker 1 (25:44):
Exactly so.
Current management reallyfocuses on alleviating the
symptoms.
This typically involvesanalgesics, pain relievers like
acetaminophen and non-steroidalanti-inflammatory drugs NSIIDs
for pain and stiffness.
Physical therapy might alsoplay a role for maintaining
function.
Speaker 2 (26:00):
What about the metabolic links?
Absolutely.
If someone with DISH also hasmetabolic syndrome or diabetes
or hypertension, then standardcare for managing those
conditions is crucial Lifestylechanges like diet and exercise
and medications if needed.
Addressing the metabolic sideis very important for overall
health.
Speaker 1 (26:19):
Okay and surgery is mostly reserved for
complications.
Speaker 2 (26:22):
Yes, surgery really comes into play for those severe
cases of symptomatic cervicaldish causing swallowing or
breathing problems, or forstabilizing those unstable
spinal fractures we justdiscussed.
Speaker 1 (26:33):
So it's mainly about managing symptoms, managing
related conditions and dealingwith complications as they arise
.
This really highlights theimportance of just being aware
of DISH, understanding thepotential connections, and this
is where a clinic likeLifeWellMD can really play a
crucial role, can it?
Speaker 2 (26:49):
Absolutely.
At LifeWellMD, our whole focusis on that comprehensive,
personalized approach to healthand longevity.
We understand that conditionslike DISH don't exist in a
vacuum.
They're often interconnectedwith metabolic health,
cardiovascular status, overallfunction.
Speaker 1 (27:03):
Looking at the whole person.
Speaker 2 (27:04):
Exactly.
Our team is really dedicated tostaying at the forefront of the
research, understanding thesecomplex interactions and using
that knowledge to provide trulypersonalized care plans.
We aim not just to treatsymptoms, but to understand and
address the underlying factorscontributing to your overall
well-being.
Speaker 1 (27:22):
So if you've been listening today and maybe
recognize some of these thingsthat chronic back stiffness,
maybe some unexplaineddifficulty swallowing, or if you
know you have risk factors formetabolic syndrome or heart
disease it might be worthconsidering if DISH could be
part of your picture.
How can listeners get in touchwith LifeWellMD to learn more?
Speaker 2 (27:42):
Yeah, if you're interested in learning more
about DISH or just want todiscuss your individual health
concerns and goals in thecontext of wellness and
longevity, we definitelyencourage you to reach out to us
at LifeWellMD.
Speaker 1 (27:52):
Okay.
Speaker 2 (27:53):
You can visit our website, that's LifeWellMDcom,
or just give us a call directlyat 561-210-9999.
Our team is here and happy toanswer your questions and help
you take that first step on yourwellness journey.
Speaker 1 (28:05):
Great.
So just to sum things up then,disg diffuse idiopathic skeletal
hyperostosis.
It's a relatively common boneforming condition, often flies
under the radar, but it hassignificant links to aging,
metabolic health, cardiovascularrisks and especially that
increased risk of spinalfractures.
Speaker 2 (28:25):
That's the core message.
Speaker 1 (28:26):
Recognizing it and understanding its potential
connections to other aspects ofyour health seems really key.
Speaker 2 (28:33):
It really is, and maybe a final thought for you to
consider as you think aboutyour own health.
Could that persistent stiffnessyou've been putting up with, or
maybe even the effects of whatseems like a minor injury, could
they possibly be connected tosomething broader, an underlying
condition like DHA?
Speaker 1 (28:49):
Food for thought.
Speaker 2 (28:50):
Being proactive, asking questions and seeking
thorough evaluations whensomething doesn't feel right.
That really empowers you totake control of your wellness
journey.
Speaker 1 (28:59):
Absolutely Well.
Thank you for walking usthrough this complex condition
today.
It's been really insightful.
Speaker 2 (29:03):
My pleasure.
It's an important topic.
Speaker 1 (29:05):
And for everyone listening.
Thank you for joining us forthis deep dive into DDAGE.
And don't forget you can visitLifeWellMDcom or call
561-210-9999 to learn more abouttheir services and take that
important first step towards ahealthier future.
Imagine this you could be walking around with a
condition affecting your bones,something that might even
increase your risk of fracturesand links to things like heart
issues, diabetes, and you mightnot even know its name.
Talking about diffuseidiopathic skeletal hyperostosis
, or DISH, it's a mouthful right.
Speaker 2 (00:21):
It really is Dish.
Speaker 1 (00:22):
It's a mouthful right , it really is.
But this deep dive is going tounpack what you need to know
about this often missedcondition and why it could be
relevant to your long-termhealth.
Speaker 2 (00:30):
Exactly.
We're taking a close look atdish today.
It's basically a conditionwhere extra bone forms in the
body.
What makes dish distinct?
Well, it's the way it oftenshows up along the spine.
You get at least three bonybridges forming along the front
and the side of the vertebrae.
Speaker 1 (00:45):
Bony bridges.
Speaker 2 (00:46):
Yeah, but it's not just the spine.
This extra bone can pop up inother places too.
Think shoulders, elbows, hips,knees, ankles, usually where
tendons and litiments attach tothe bone.
Those are called emphases.
So these bony bridges formingit almost sounds like your
body's trying to fuse itself.
Maybe In a way, yeah, but it'snot necessarily a good thing.
This extra bone, as we'llexplore understanding dish, is
(01:10):
really important.
It's linked to a higher chanceof spinal fractures for one
Right and, maybe surprisingly,it has strong connections to
things like metabolic syndrome.
Speaker 1 (01:19):
Which includes high blood pressure cholesterol
issues.
Speaker 2 (01:21):
Exactly, and potential issues with your heart
, even your breathing Wow.
And that's why we at LifeWellMDwe're an innovative clinic down
here in Florida specializing inhealth, wellness and longevity
we feel it's just so importantto bring conditions like DISH
into the light.
Speaker 1 (01:38):
Makes sense.
Speaker 2 (01:39):
We're really dedicated to helping you
understand your body's signals,you know, and take proactive
steps towards better health.
If you're curious to learn moreabout how we do things, you can
always visit us atLifeWellMDcom.
Speaker 1 (01:51):
Good to know, so let's start with that name, then
Diffuse Idiopathic SkeletalHyperostosis.
It kind of tells a story,doesn't it?
Speaker 2 (02:00):
It does.
Yeah, it's evolved quite a bitover time.
Speaker 1 (02:02):
I think it started with something more basic.
Speaker 2 (02:04):
That's right.
Initially it was often justcalled hyperostosis in the
spinal column Prettystraightforward, it's true too.
Then later it became known asForrester's disease, named after
the doctors who really broughtattention to it back in the
mid-20th century.
Okay, and the term D-SAGE, theone we use most commonly now,
that came about in the mid-70s,coined by researchers Resnick
(02:26):
and colleagues who were lookingfor a more precise description.
Speaker 1 (02:30):
And if you break down desage, each part of the name
gives you a clue.
Speaker 2 (02:35):
Exactly.
Speaker 1 (02:35):
Diffuse suggests it's widespread, not just one spot.
Idiopathic tells us.
The exact cause is still well apuzzle.
Speaker 2 (02:43):
It's all unknown, yeah.
Speaker 1 (02:44):
Skeletal points to the bones, obviously, and
hyperostosis just means extrabone growth.
Yep, same.
So DSH is all right there inthe name.
Now, how do doctors actually goabout diagnosing this?
What are they looking for?
Speaker 2 (02:56):
Well, the real breakthrough in diagnosing DSH
came back in 1976.
That was with Resnick andNuwayama.
They established radiographiccriteria things you can actually
see on an x-ray and theircriteria have really been the
cornerstone for how disease isidentified, especially in
research settings.
The first key thing is seeingflowing calcification and
(03:17):
ossification.
Speaker 1 (03:18):
Flowing Like liquid bone almost.
Speaker 2 (03:21):
Kind of yeah, along the front and side, the
anterolateral aspects of atleast four vertebrae, one after
the other in a row.
Think of it like a smooth,continuous pour of extra bone
linking these vertebrae together.
Speaker 1 (03:35):
Okay, so not like sharp individual bone spurs, but
these smoother flowingconnections, and it has to be at
least four vertebrae.
Speaker 2 (03:42):
At least four according to those original
criteria.
Then the second part is thateven with all this extra bone,
the spaces between the vertebraewhere the discs live, they
should still look relativelynormal in height.
Speaker 1 (03:53):
Right, so the discs aren't collapsing like you might
see in typical arthritis ordegeneration.
Speaker 2 (03:57):
Exactly, and they shouldn't see other big signs of
degenerative disc diseaseeither, like gas pockets in the
discs or significant hardeningof the vertebral edges.
Speaker 1 (04:07):
Okay, so the disc spaces are still holding up,
acting like spacers betweenthose bony bridges.
And the third piece.
What's the last part of thecriteria?
Speaker 2 (04:14):
The final criterion is the absence of fusion in the
small joints at the back of thespine.
Those are the epiphysial joints, or facet joints, and no
significant issues like erosion,sclerosis or fusion in the
sacroiliac joints.
That's where your spineconnects down to your pelvis.
Speaker 1 (04:32):
So these criteria really help doctors tell Dish,
apart from other things thatcause spinal stiffness or fusion
, maybe like ankle-losingspondylitis?
Speaker 2 (04:41):
Precisely.
It's like having a specificchecklist to identify dish on an
x-ray Got it?
But it's important to remember.
These criteria are developed tospot more advanced cases,
particularly in the spine.
Speaker 1 (04:52):
Right.
Speaker 2 (04:53):
They might not always pick up on earlier stages or
dish that's mainly affectingother parts of the body, like
the elbows or heels.
Speaker 1 (04:59):
Okay.
Speaker 2 (05:00):
And actually over the years researchers have proposed
lots of different diagnosticcriteria.
I think maybe around two dozenin total.
Speaker 1 (05:07):
Two dozen, Wow.
That's a lot of different waysto look at it.
What were the main differencesbetween them?
Speaker 2 (05:12):
Well, the most consistent thing across almost
all of them was that new bonebridging on the front of the
vertebrae.
That was pretty central Okay.
Speaker 1 (05:18):
But they differed in the details.
Speaker 2 (05:20):
Yeah.
Speaker 1 (05:23):
Like exactly how many vertebrae needed to be involved
?
How complete did those bonybridges have to be?
How well preserved did thediscs and other spinal joints
need to look?
Did they include bone growthand other joints?
You know peripheral andthesopathies, and even how they
looked just x-rays orincorporating newer imaging like
CT scans.
Speaker 2 (05:39):
It really sounds like the field is still maybe
fineuning the best way to defineand diagnose DSH, especially in
earlier stages or when it showsup outside the spine.
Speaker 1 (05:49):
Absolutely, and in rheumatology we often
distinguish betweenclassification criteria and
diagnostic criteria.
Speaker 2 (05:57):
What's the difference there?
Speaker 1 (05:58):
Well.
Classification criteria areusually straighter.
They're used in research tomake sure everyone's studying a
very similar, specific group ofpatients.
Diagnostic criteria are whatdoctors use day to day in the
clinic to identify the conditionin an individual patient.
Speaker 2 (06:12):
The resonant criteria are great for research because
they're very specific.
They really nail down classicDISH.
But they might be too strictsometimes for clinical use.
They could potentially excludesomeone who has DISH but maybe
also has some signs ofosteoarthritis in those facet
joints, for instance.
They might be too strictsometimes for clinical use.
They could potentially excludesomeone who has DISH but maybe
also has some signs ofosteoarthritis in those facet
joints for instance.
Speaker 1 (06:30):
So the research definition is super precise for
studying DISH alone, but in thereal world, doctors need to look
at the whole picture for eachpatient.
Okay, so we know what DISHlooks like and how it's
generally diagnosed, but what'sactually causing this extra bone
to grow?
What's going?
Speaker 2 (06:47):
on inside the body.
That is the million dollarquestion and the honest answer
is the exact cause.
The pathogenesis of DISH isstill unknown.
Speaker 1 (06:55):
Really Still idiopathic.
Speaker 2 (06:56):
Still idiopathic.
We have a lot of clues, a lotof associations we'll talk about
, but the full picture, itremains elusive.
Speaker 1 (07:03):
All right, let's dive into those clues then.
What does the extra boneactually look like up close
under a microscope?
Speaker 2 (07:08):
Microscopically.
Yeah, you see, these bonybridges are directly connected
to the existing bone of thevertebrae.
It's mostly cortical bone, thatdense outer layer.
Speaker 1 (07:16):
The hard stuff.
Speaker 2 (07:17):
The hard stuff, yeah, but there's also some
cancellous bone, the more spongyinner part, and interestingly
they've also found woven bone.
Speaker 1 (07:25):
Woven bone.
What does that mean?
Speaker 2 (07:31):
Woven bone suggests it's an active process.
It's often laid down quicklyduring periods of bone formation
or remodeling.
Think of it like the initialscaffolding that gets refined
into stronger lamellar bone overtime.
So its presence tells us thisisn't just old static bone.
There's ongoing activity.
Speaker 1 (07:43):
So it's not just a one-time event.
It's an ongoing process of boneformation and change and since
this often happens where tendonsand ligaments attach those
emphases you mentioned, whatdoes that suggest about
potential causes?
Speaker 2 (07:57):
Well, that location really points towards a complex
mix of factors probablyinfluencing the cells in those
areas.
You've got fibroblasts makingconnective tissue, chondrocytes,
which are cartilage cells plusthe collagen fibers and the
mineral matrix.
So researchers are looking at acombination of things genetic
predisposition, maybe vascularfactors, blood supply, metabolic
(08:17):
influences which seem reallykey, and even mechanical stress
on those attachment points.
Speaker 1 (08:22):
It sounds like a lot of potential players in this
game.
Now we touched on some thingsthat seem more common in people
with DISH.
What do we know about thebigger picture, the
epidemiological associations,the risk factors?
Speaker 2 (08:37):
Yeah, we've definitely identified several
strong links.
The most notable ones areincreasing age being, male
obesity, high blood pressure andhaving conditions like diabetes
and metabolic syndrome.
Speaker 1 (08:47):
Let's start with age.
That seems like a prettyconsistent factor across the
board, doesn't it?
Speaker 2 (08:51):
Absolutely.
Study after study looking athow common DISH is in different
populations shows a clear trendthe older you get, the more
likely you are to have DISH.
Speaker 1 (09:00):
Right.
Speaker 2 (09:01):
When researchers compare the average age of
people with DISH to thosewithout the DISH, group is
consistently older, and if youlook decade by decade, the
prevalence just keeps climbingsignificantly.
Speaker 1 (09:10):
So it's definitely a condition that becomes much more
common as we age.
What about gender?
You mentioned being male is afactor.
Speaker 2 (09:17):
Yes, numerous studies have found a much higher
prevalence of DISH in mencompared to women.
Some studies report ratios ashigh as like seven men for every
one woman with this dish.
Speaker 1 (09:27):
Wow, seven to one.
Speaker 2 (09:29):
Yeah, although it's worth noting some of those
studies maybe had smallernumbers or didn't fully account
for other factors, but the trendis definitely there and,
interestingly, it seems, thisgap between men and women widens
even more as people get older.
Speaker 1 (09:42):
That's quite a difference.
Okay, now let's talk aboutwheat.
There seems to be a strongconnection with obesity.
Speaker 2 (09:48):
That's right.
Pretty much every study thathas looked at the relationship
between DISH and body mass index, bmi, has found that people
with DISH tend to have a higherBMI.
And what's really telling iseven when researchers use
statistics to adjust for otherthings that might be linked like
(10:10):
age, this connection betweenDISH and higher BMI stays
significant.
Speaker 1 (10:12):
So it's not just that older people might be heavier
and have DISH.
There seems to be a more directlink.
What about high blood pressure?
Speaker 2 (10:16):
Hypertension yeah, also seen more often in people
with DISH compared to thosewithout.
Now, not every single study hasshown this to be statistically
significant, but several have,and a couple even found that the
systolic blood pressure in thetop number tends to be a bit
higher in individuals withDISH-E.
Speaker 1 (10:33):
Okay, another piece pointing towards metabolic
health.
Speaker 2 (10:35):
Yeah.
Speaker 1 (10:36):
And diabetes Diabetes mellitus?
Speaker 2 (10:38):
yes, Several studies have found that it's
significantly more common inpatients with DISH.
Others have also seen a trendtowards higher rates in the DISH
group, even if the statisticsdidn't quite reach significance
in their particular study.
Speaker 1 (10:51):
So again, it seems like DISH might travel in the
same circles as these metabolicissues.
You mentioned the broaderconcept too, metabolic syndrome.
Speaker 2 (10:58):
Yes, exactly.
When you look at metabolicsyndrome as a whole, that
cluster of risk factors.
When you look at metabolicsyndrome as a whole, that
cluster of risk factorsincreased waist size, high
triglycerides, low goodcholesterol, hdl high blood
pressure, high fasting bloodsugar.
Speaker 1 (11:11):
Right.
Speaker 2 (11:12):
There's a strong correlation with DSH.
Some of those individual partsseem more strongly linked than
others.
For example, highertriglycerides are more common
but maybe not alwaysstatistically significant on
their own.
But increased waistcircumference, higher blood
pressure and elevated fastingglucose those seem to be key
drivers of this associationbetween metabolic syndrome and
Dietsch.
Speaker 1 (11:32):
It's really starting to paint a picture, isn't it?
Dish seems to be more than justa bone thing.
It might be another signpointing towards these
underlying metabolic problems.
What about the heart and bloodvessels directly?
Speaker 2 (11:43):
That's interesting too.
While general cardiovascularevents like heart attacks or
strokes haven't consistentlybeen reported as much more
common in dish, some specificfindings are quite suggestive.
For instance, hardening of theaorta aortic sclerosis has been
found significantly more oftenin the DISH group, even after
adjusting for age and sex.
Similarly, calcium buildupcalcifications in the aorta and
(12:07):
also in the coronary arteriesthat supply the heart muscle
that's also seen more frequentlyin people with a DISH, even
when you account for things likeage, bmi and gender.
So it suggests a potential linkbetween dish and the health of
our larger blood vessels.
Speaker 1 (12:21):
That's a really important connection.
It makes you wonder if dishcould be, I don't know, an early
indicator or just part of abigger process affecting the
vascular system.
What about other parts of thebody, our lungs, for example?
Speaker 2 (12:33):
Yeah, there's an association found between dish
and lower lung volumes.
Speaker 1 (12:36):
Lower lung volumes.
How?
Speaker 2 (12:38):
Well, the thinking is that the bone growth in the
spine, especially the thoracicspine, could potentially extend
to where the ribs attach.
This could lead to a stifferrib cage less able to expand
fully.
Speaker 1 (12:51):
Right.
Speaker 2 (12:58):
And this is supported by findings of restrictive
patterns on pulmonary functiontests.
Breathing tests in with Disheshindicating a reduced capacity
to get air in, and this couldeven have implications
potentially increasing the riskof things like pneumonia,
especially in older adults witha less mobile chest wall.
Speaker 1 (13:09):
So a bone condition could actually impact how well
you breathe.
That's a connection most peopleprobably wouldn't make.
What about lifestyle factorslike smoking or drinking?
Do they play a role?
Speaker 2 (13:19):
Well, the findings on smoking and dishish have been
pretty inconsistent acrossstudies.
Some found more smokers in thegroup, others didn't, so can't
really draw a firm conclusionthere right now.
Ok, and similarly with regularalcohol consumption, after
accounting for other factors,there doesn't seem to be a
strong, clear link to dishish.
Speaker 1 (13:38):
So, unlike the clearer links with age and
metabolic factors, thoselifestyle habits don't seem to
have a consistent relationship.
Speaker 2 (13:45):
Got it Now.
There's a common idea out there, isn't there?
That dish is simply thehardening, the ossification of
that big ligament running downthe front of our spine, the AL,
the anterior longitudinalligament.
Is that what's happening?
Speaker 1 (13:59):
Ah, yes, that's a really common misunderstanding.
Yeah, but the evidence actuallypoints to something different.
Speaker 2 (14:05):
Oh.
Speaker 1 (14:05):
When researchers have looked closely, macroscopically
at spines with DISH, they foundthat the ALL, the ligament
itself, is actually stillpresent.
It's usually in its normalposition right in the midline,
at the levels where there isn'tany new bone growth, but where
the bony bridges do form,typically on the side.
The AL is often found pushedaway, displaced to the side, by
(14:27):
the new bone.
Speaker 2 (14:28):
So the new bone isn't just the ligament turning into
bone, it's actually formingalongside it and sort of
shouldering it out of the way.
Speaker 1 (14:34):
Exactly, it's forming adjacent to, and often anterior
or anterolateral to, theligament, not necessarily within
it.
That's a really importantdistinction.
It is Good to clarify that.
Now, what about genetics?
Does this run in families?
Speaker 2 (14:49):
There are definitely hints that genetics might be
involved.
Yes, we've seen reports offamilial occurrences disease
running in families, whichsuggests a possible inherited
predisposition.
Speaker 1 (15:00):
Interesting.
Speaker 2 (15:00):
Also kind of an interesting side note in the
veterinary world.
Certain dog breeds, like boxerdogs, have a significantly
higher rate of DISH than otherbreeds.
Speaker 1 (15:10):
Boxers.
Speaker 2 (15:11):
Yeah, and there's even a mouse model that
researchers use which mimicssome features of DISH In humans.
Some preliminary studies havelooked at variations, single
nucleotide polymorphisms or SNPsin specific genes like KOL6A1
and FGF2 and found potentiallinks, but this is still really
early days.
Speaker 1 (15:30):
So needs more research.
Speaker 2 (15:31):
Definitely we need larger studies like genome-wide
association studies, gwas, toreally map out the genetic
factors involved.
But the clues are there,suggesting genetics likely plays
some part.
Speaker 1 (15:41):
OK, let's circle back to where this extra bone tends
to form.
You mentioned it's often on thefront and sides and kind of
asymmetrical in the mid-back,the thoracic spine.
Why that specific pattern?
Speaker 2 (15:52):
Yeah, that pattern is fascinating and that's where
vascular factors blood vesselslikely play a role.
The thinking is that the newbone tends to form in areas that
are away from major pulsatingblood vessels like the aorta.
Speaker 1 (16:04):
Oh, the big artery.
Speaker 2 (16:05):
Exactly In the lower thoracic spine.
The aorta usually sits slightlyto the left.
And guess what?
The dish bone formation isoften more prominent on the
right side in that region.
Avoiding the pulse.
It seems so, and even moretelling in rare cases where
people have sedus inverses,where their organs are flipped.
Mirror image.
Speaker 1 (16:24):
Right heart on the right side, etc.
Speaker 2 (16:26):
Exactly In those individuals with DISH, the bony
bridges in the thoracic spinehave been observed to be
predominantly on the left side,the opposite of usual.
Speaker 1 (16:35):
Wow, that strongly suggests the aortus pulsation
influences where the bone forms,or rather where it doesn't form
.
Speaker 2 (16:42):
Precisely, it seems to avoid those strong pulsations
.
Speaker 1 (16:45):
What about the flowing nature of the bone?
Does blood flow play a rolethere too?
Speaker 2 (16:48):
Well, it's been proposed that the smaller
segmental blood vessels, theones that cross the vertebrae
around the middle of the body,might somehow contribute to that
flowing pattern, maybe byproviding nutrients or signals.
Speaker 1 (17:00):
Okay.
Speaker 2 (17:01):
And the fact that the cervical spine, the neck, which
doesn't have quite the samevascular setup, tends to have
less of that classic, smoothflowing bone formation, might
lend some support to that idea.
Speaker 1 (17:13):
Interesting.
Speaker 2 (17:14):
Also, some studies have found an increased number
and size of the little holes inthe vertebrae where blood
vessels enter the nutrientforamina, and signs of increased
blood muscle activity,hypervascularity in areas
affected by DISH A chicken oregg.
Exactly.
We're still trying to figureout if this increased blood flow
is a cause helping fuel thebone growth or if it's simply a
(17:35):
consequence of the active boneformation process right, still
more questions than answersthere.
Speaker 1 (17:40):
Now we've touched on genetics, blood vessels.
Yeah, let's still have a bitdeeper into the metabolic and
molecular theories.
We know there's that stronglink with metabolic syndrome.
How might that actuallycontribute to dish at a cellular
level?
Speaker 2 (17:53):
well, one hypothesis may be a bit simplistic is that
in people with obesity andmetabolic syndrome there might
just be sort of an excess ofenergy available systemically,
extra fuel that couldpotentially be channeled into
this extra bone formation.
Speaker 1 (18:07):
Like the body, has resources to spare for building
bone.
Speaker 2 (18:10):
Potentially, but of course that doesn't fully
explain why it targets the spineand emphases specifically.
Another related theory focusesmore on the type of fat Higher
amounts of visceral fat, the fataround the organs which is
common in metabolic syndrome.
That type of fat ismetabolically active and tends
to release more pro-inflammatorycytokines, these signaling
(18:31):
molecules.
So it's thought that thischronic low-level inflammation
associated with visceral obesitycould play a role in promoting
bone growth at susceptible sites.
Speaker 1 (18:40):
That makes sense.
Inflammation seems to beinvolved in so many chronic
conditions.
What about specific hormones ormolecules?
Anything identified as a driver?
Speaker 2 (18:49):
Yeah, some studies have found that levels of growth
hormone GH and insulin-likegrowth factor 1, igf-1, both
known to promote bone growth,tend to be higher in people with
D-ish, and researchers areactively investigating various
signaling pathways that controlbone formation, things like the
WANT pathway, nf-kappa B, bonemorphogenetic protein 2, bmp2,
(19:12):
prostaglandin I2, and thalin-1.
These are all potential playersbeing looked at.
Speaker 1 (19:17):
A lot of molecular targets.
Speaker 2 (19:18):
Yes, but again, we're still in the fairly early
stages of figuring out exactlyhow these pathways are
dysregulated or contributespecifically to dish development
.
Much more research needed there.
Speaker 1 (19:29):
It really sounds like we're chipping away at
understanding the mechanisms.
Yeah, but that precise triggerfor dish is still well
idiopathic.
Now let's shift gears a bit andtalk about why this all matters
to you, the listener.
We mentioned DISH is oftenoverlooked.
What are the real-worldclinical implications of having
DISH beyond just seeing it on anx-ray?
Speaker 2 (19:47):
Right, because DISH can often be present without
causing obvious symptoms orbecause its symptoms, like
stiffness, can mimic othercommon conditions like
osteoarthritis, it often fliesunder the radar.
However, as we've discussed,those strong links to metabolic
health, cardiovascular risks andrespiratory issues mean that
identifying it can be clinicallyvery important for managing
(20:08):
your overall health andwell-being.
Speaker 1 (20:10):
Let's talk about the symptoms people might experience
.
What kind of pain or functionallimitations are common?
Speaker 2 (20:16):
Back pain and stiffness are definitely common
complaints.
Some studies show you know70-80% of people with DISH
reporting these symptoms.
Speaker 1 (20:23):
Okay.
Speaker 2 (20:24):
But interestingly, when researchers directly
compare people with DISH tocontrol groups without it, the
findings on back pain itself canbe a bit mixed.
Some studies don't find asignificant difference in pain
levels.
Speaker 1 (20:36):
Really, that's, surprising.
Speaker 2 (20:38):
Yeah, and one study even suggested that maybe the
extra bone, by stabilizing thespine somewhat, could
potentially lead to less backpain in some individuals.
Kind of a natural fusion effectperhaps.
Speaker 1 (20:49):
Huh, a double-edged sword then less movement, but
maybe less pain sometimes, butit sounds like flexibility is
usually affected.
Speaker 2 (20:55):
Yes, difficulty bending is a commonly reported
issue and some research hasshown that things like grip
strength can be lower in peoplewith DISH, suggesting maybe a
broader impact on overallphysical function, not just the
spine.
We really need more long-termlongitudinal studies to track
how pain and flexibility changeover time in different stages of
(21:17):
DISH.
Speaker 1 (21:18):
Makes sense?
And what about when DISHaffects other joints like
shoulders, elbows, ankles?
Speaker 2 (21:23):
Yeah, when dish affects those peripheral joints,
it can certainly cause pain,stiffness and reduced range of
motion, similar toosteoarthritis, which it can
also coexist with.
Heel spurs are a commonmanifestation too, Okay,
Although, again surprisingly,some studies have even reported
less joint pain or stiffness inthe dish group compared to
controls.
But those studies might havehad limitations, so we need to
(21:44):
interpret that cautiously.
Speaker 1 (21:45):
So the clinical picture can be really varied.
What about some of the moreserious complications we touched
on earlier?
Difficulty, swallowing orbreathing problems.
Speaker 2 (21:53):
Right, because the extra bone growth in the neck,
the cervical spine, happens onthe front side.
It can sometimes physicallypress on or displace the
esophagus and the trachea.
Speaker 1 (22:03):
The swallowing tube in the windpipe.
Speaker 2 (22:05):
Exactly.
This can lead to difficultyswallowing, which we call
dysphagia, and in rarer butpotentially serious cases, it
can even cause airwayobstruction or breathing
difficulties.
Speaker 1 (22:16):
Is that common?
Speaker 2 (22:17):
Well, it's often described as rare, but a
systematic review of the medicalliterature actually found at
least 200 reported cases ofdysphagia or airway issues
linked to cervical dish, so itmight be more prevalent than we
think, perhaps under-recognizedor misattributed sometimes.
Speaker 1 (22:35):
Okay, and is there a treatment for that?
Speaker 2 (22:37):
Yes, treatment can range from conservative measures
, dietary changes, therapy, tosurgery to actually remove the
excess bone, the osteophytes,although there is a chance the
bone could grow back over time.
Speaker 1 (22:48):
That sounds like a situation where catching it
early is really important.
And then there's the othermajor concern you mentioned, the
increased risk of spinalfractures.
That sounds particularlyworrying.
Speaker 2 (22:58):
It is a significant concern.
Yes, A spine that's stiffenedby dish is less flexible.
It acts more like a single longbone rather than a series of
flexible segments.
Speaker 1 (23:09):
Right.
Speaker 2 (23:10):
So when there's trauma, even sometimes
relatively minor trauma, theenergy isn't dissipated across
multiple levels, it concentratesand the spine is much more
prone to fracture.
The risk is estimated to beabout four times higher than in
a non-dish spine.
Speaker 1 (23:24):
Four times higher.
Speaker 2 (23:25):
And, crucially, these fractures have a much higher
chance of causing spinal cordinjury, up to maybe 58% in some
reports.
Speaker 1 (23:33):
Wow, so the stiffness makes it brittle, essentially.
Speaker 2 (23:35):
In effect, yes, it leads to more unstable fracture
patterns, oftenhyperextension-type injuries,
and because the disc spaces areoften bridged by bone, the
fracture line frequently goesright through the vertebral body
itself, rather than just thedisc.
Speaker 1 (23:49):
And these fractures are generally more serious in
people with DISH.
Speaker 2 (23:53):
Yes, they tend to be more unstable mechanically.
They carry that higher risk ofneurological damage and they can
lead to more complicationsduring treatment and recovery.
Early diagnosis is absolutelycritical to prevent further
displacement of the fracture andpotential worsening of any
neurological injury.
Speaker 1 (24:10):
But diagnosis can be tricky.
Speaker 2 (24:12):
It can be.
Unfortunately, there's often adelay in diagnosing these
fractures.
Reported delays anywhere from19 to 41 percent of cases.
Speaker 1 (24:19):
Why is that?
Speaker 2 (24:20):
Well, sometimes the initial trauma might seem
minimal like a simple fall fromstanding height.
Dosing these fractures reporteddelays anywhere from 19 to 41
percent of cases.
Why is that?
Well, sometimes the initialtrauma might seem minimal, like
a simple fall from standingheight.
The patient might not have adramatic increase in their usual
baseline back pain, andstandard x-rays can be really
difficult to interpret becausethe underlying dish already
makes the spine look complex.
Speaker 1 (24:36):
So what's recommended ?
Speaker 2 (24:38):
Clinicians really need to have a high index of
suspicion for fracture in anyonewith known DGISH who
experiences trauma, even minortrauma.
Ct scans are often necessary toclearly see the fracture
pattern, and a low threshold forgetting an MRI is important too
, especially to assess thespinal cord and ligaments.
Okay, and treatment.
Treatment usually involvessurgery to stabilize the spine.
(24:59):
This has been shown to improvesurvival and neurological
outcomes.
Often posterior fixation withscrews and rods is preferred For
certain fracture types withoutneurological deficit less
invasive percutaneous techniquesmight be an option.
Speaker 1 (25:15):
So if you have DISH and you have any kind of fall or
accident, it's really crucialto get checked out thoroughly,
being aware of this higherfracture risk.
Speaker 2 (25:24):
Okay.
So, given all this, what arethe actual treatment options for
dish itself, not just thecomplications.
Speaker 1 (25:30):
That's the challenge, Because we don't yet fully
understand the underlying cause,the pathogenesis.
There's currently no specifictreatment to stop the bone from
forming or to reverse theprocess.
Speaker 2 (25:41):
Right.
Still waiting on understandingthe idiopathic part.
Speaker 1 (25:44):
Exactly so.
Current management reallyfocuses on alleviating the
symptoms.
This typically involvesanalgesics, pain relievers like
acetaminophen and non-steroidalanti-inflammatory drugs NSIIDs
for pain and stiffness.
Physical therapy might alsoplay a role for maintaining
function.
Speaker 2 (26:00):
What about the metabolic links?
Absolutely.
If someone with DISH also hasmetabolic syndrome or diabetes
or hypertension, then standardcare for managing those
conditions is crucial Lifestylechanges like diet and exercise
and medications if needed.
Addressing the metabolic sideis very important for overall
health.
Speaker 1 (26:19):
Okay and surgery is mostly reserved for
complications.
Speaker 2 (26:22):
Yes, surgery really comes into play for those severe
cases of symptomatic cervicaldish causing swallowing or
breathing problems, or forstabilizing those unstable
spinal fractures we justdiscussed.
Speaker 1 (26:33):
So it's mainly about managing symptoms, managing
related conditions and dealingwith complications as they arise
.
This really highlights theimportance of just being aware
of DISH, understanding thepotential connections, and this
is where a clinic likeLifeWellMD can really play a
crucial role, can it?
Speaker 2 (26:49):
Absolutely.
At LifeWellMD, our whole focusis on that comprehensive,
personalized approach to healthand longevity.
We understand that conditionslike DISH don't exist in a
vacuum.
They're often interconnectedwith metabolic health,
cardiovascular status, overallfunction.
Speaker 1 (27:03):
Looking at the whole person.
Speaker 2 (27:04):
Exactly.
Our team is really dedicated tostaying at the forefront of the
research, understanding thesecomplex interactions and using
that knowledge to provide trulypersonalized care plans.
We aim not just to treatsymptoms, but to understand and
address the underlying factorscontributing to your overall
well-being.
Speaker 1 (27:22):
So if you've been listening today and maybe
recognize some of these thingsthat chronic back stiffness,
maybe some unexplaineddifficulty swallowing, or if you
know you have risk factors formetabolic syndrome or heart
disease it might be worthconsidering if DISH could be
part of your picture.
How can listeners get in touchwith LifeWellMD to learn more?
Speaker 2 (27:42):
Yeah, if you're interested in learning more
about DISH or just want todiscuss your individual health
concerns and goals in thecontext of wellness and
longevity, we definitelyencourage you to reach out to us
at LifeWellMD.
Speaker 1 (27:52):
Okay.
Speaker 2 (27:53):
You can visit our website, that's LifeWellMDcom,
or just give us a call directlyat 561-210-9999.
Our team is here and happy toanswer your questions and help
you take that first step on yourwellness journey.
Speaker 1 (28:05):
Great.
So just to sum things up then,disg diffuse idiopathic skeletal
hyperostosis.
It's a relatively common boneforming condition, often flies
under the radar, but it hassignificant links to aging,
metabolic health, cardiovascularrisks and especially that
increased risk of spinalfractures.
Speaker 2 (28:25):
That's the core message.
Speaker 1 (28:26):
Recognizing it and understanding its potential
connections to other aspects ofyour health seems really key.
Speaker 2 (28:33):
It really is, and maybe a final thought for you to
consider as you think aboutyour own health.
Could that persistent stiffnessyou've been putting up with, or
maybe even the effects of whatseems like a minor injury, could
they possibly be connected tosomething broader, an underlying
condition like DHA?
Speaker 1 (28:49):
Food for thought.
Speaker 2 (28:50):
Being proactive, asking questions and seeking
thorough evaluations whensomething doesn't feel right.
That really empowers you totake control of your wellness
journey.
Speaker 1 (28:59):
Absolutely Well.
Thank you for walking usthrough this complex condition
today.
It's been really insightful.
Speaker 2 (29:03):
My pleasure.
It's an important topic.
Speaker 1 (29:05):
And for everyone listening.
Thank you for joining us forthis deep dive into DDAGE.
And don't forget you can visitLifeWellMDcom or call
561-210-9999 to learn more abouttheir services and take that
important first step towards ahealthier future.
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