Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Cohort Study from Sweden and Japan.

STUDY DESIGN: We retrospectively reviewed computed tomography (CT) records of patients in Japan and Sweden, which are both aging populations. OBJECTIVE: To research the influence of ethnicity and region on diffuse idiopathic skeletal hyperostosis (DISH) prevalence. SUMMARY OF BACKGROUND DATA: DISH can complicate non-surgical treatment of spinal fractures and often requires surgical intervention. We previously reported a prevalence of DISH in Japan that was higher than that reported in other studies. METHODS: We retrospectively reviewed CT records of patients in Japan and Sweden, which have both aging populations. Patients undergoing whole body CT during trauma examinations at an acute outpatient clinic in Uppsala University Hospital in a 1-year period were eligible for inclusion. Excluded were those less than 40 and more than or equal to 90 years old, and those with previous spinal surgery. The prevalence of DISH by sex and age was determined according to radiographic criteria by Resnick. Results from Sweden were compared with the Japan data, which we previously reported. RESULTS: Age of the eligible subjects (265 men and 153 women) ranged from 40 to 89 years, with a mean age of 63.4 years. Among men, 86 (32.5%) were diagnosed with DISH, and the results by age (40s, 50s, 60s, 70s, and 80s) were: 6 (10.7%), 13 (22%), 35 (46.1%), 17 (34%), and 15 (62.5%) patients, respectively. Among women, 16 (10.5%) had DISH, and the results by age were as follows: 1 (2.6%), 1 (3.3%), 2 (6.7%), 6 (22.2%), and 6 (22.2%) patients, respectively. These results did not differ from those previously published for Japan (Fisher exact test, men: P = 1, 0.27, 0.12, 0.06, and 1, respectively; women: P = 0.49, 0.62, 0.5, 0.8, and 0.3, respectively). CONCLUSION: The presented cohort study revealed that ethnicity and region may not be notable factors of DISH prevalence, since patients from both Japan and Sweden had similar DISH prevalence. LEVEL OF EVIDENCE: 3.

Diffuse idiopathic skeletal hyperostosis (DISH): Increased prevalence in Pacific Islanders.

INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH) is a musculoskeletal disorder in which ligaments and entheses slowly become ossified, leading to decreased mobility and pain. The prevalence is variably reported as between 3% and 25% of the population over 50. In Australasia, the prevalence and severity of DISH has long been thought by radiologists to be high in certain populations, particularly among Pacific Islanders. The purpose of this study is to investigate the prevalence and severity of DISH in a Pacific Islander community. METHODS: Chest radiographs in 459 individuals were retrospectively reviewed to assess for the presence of features consistent with DISH, as per the Resnick Criteria. Each radiograph was also assessed for the number of vertebral bodies involved. The clinical records of these patients were accessed to obtain the patient's ethnicity. RESULTS: The prevalence of DISH in our group overall was 138/459 (30%) with a prevalence of 42/96 (44%) in the Pacific Islanders. The difference compared to the Europeans in the group is highly significant (P < 0.0001). CONCLUSIONS: This study verifies the high prevalence of DISH in Pacific Islanders.

Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study.

STUDY DESIGN: A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. OBJECTIVE: To investigate the association of DISH with Cobb angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study. SUMMARY OF BACKGROUND DATA: DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb angle of kyphosis. METHODS: Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb angle was analyzed using linear regression. Cobb angle and DISH relationship was assessed at different spine levels (thoracic and lumbar). RESULTS: DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb angle of 2.9° and 95% CI (0.5-5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb angle of 10.6° and 95% CI (6.5-14.7) in African Americans and a Cobb angle of 3.8° and 95% CI (1.0-6.5) in Caucasians compared with those with no DISH. CONCLUSION: DISH is associated with greater Cobb angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb angle is stronger within the African American population.

Isotopic examination of links between diet, social differentiation, and DISH at the post-medieval Carmelite Friary of Aalst, Belgium.

Stable isotope ratios (δ(13) C and δ(15) N) were measured in human burials from the post-medieval (16th-18th c. AD) Carmelite friary burial grounds at Aalst, a town in Flanders, Belgium. Dietary patterns of 39 adult individuals were analyzed, from a mixed monastic and lay population buried in three different locations, reflecting groups with differing social status. The data show significant variation in the consumption of perhaps meat, but certainly also marine protein between females and males. This result represents a remarkable continuity with medieval dietary patterns, suggesting that the social and economic changes of the early modern period had a limited effect on everyday life. When both sexes were examined together, individuals buried in the cloister garth consumed significantly less marine protein compared to people buried in the church, likely reflecting social stratification. No statistical differences were observed between isotopic values from the church and the cloister alley, suggesting a similarly diverse diet of the monastic part of the buried population and that of the richer lay population. Finally, the hypothesis that diffuse idiopathic skeletal hyperostosis (DISH) is linked to a diet rich in animal protein was tested. No systematic or statistically significant differences between pathological and non-pathological bones from the same individuals affected with DISH were observed, and no statistical differences were found between individuals with DISH and individuals without DISH.

The prevalence of diffuse idiopathic skeletal hyperostosis in Korea.

OBJECTIVE: To identify the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a large Asian population group. METHODS: A total of 3595 subjects (1616 men and 1979 women) over 50 years of age, residing in 2 cities in Korea, were included in this study. The mean age of the study population was 64.25 +/- 9.06 years. We reviewed lateral chest radiographs through Picture Archiving and Communication Systems (PACS) and identified DISH according to Resnick's and Julkunen's criteria. RESULTS: One hundred and four (2.9%) of the 3595 subjects were diagnosed with DISH according to classical Resnick criteria. A slight increase in prevalence (4.1%) could be seen using Julkunen's criteria. The prevalence of DISH increased with age, except for the 90-99 year age group. Men were approximately 7 times more likely to have DISH than women using Resnick's criteria. CONCLUSION: DISH is an age-related skeletal disorder whose overall prevalence is much lower in Koreans than in other Western populations. Interestingly, the prevalence of DISH was 7 times higher in men. We propose that ethnic factors are important elements in the prevalence of DISH.

The demographic and clinical spectrum of Arab versus Asian patients with ankylosing spondylitis in the UAE.

Ankylosing spondylitis is a rather uncommon condition in the UAE. Over a period of 10 years. 28 hospital-based patients diagnosed as having AS were retrospectively studied. They included 17 Arabs and 11 Asians. The onset of AS in most patients in this study was in adulthood (mean age at onset was 27.7 years in Arabs and 28.75 years in Asians). HLA B27 was positive in 56 and 81% in these two populations, respectively (P > 0.05). Analysis of these figures, however, along with previous relevant published data, could indicate that Arabs with AS are less likely to be B27-positive than Asians. Among the Arab patients there was not a single case from the local community, which could be attributed to the extremely low rate of B27 phenotype in their normal population. The interracial variations in the frequency of clinical features were statistically insignificant, therefore indicating some degree of similarity in the form and disease expression in both groups. AS is characterized as being predominantly axial in the majority of our patients. Extraspinal (oligo-poly) arthropathy involved mainly hips and knees, and there have been fewer extra-articular manifestations compared with other series published.