Diffuse idiopathic skeletal hyperostosis (DISH) and trabecular bone score (TBS) in postmenopausal women: The Camargo cohort

Effect of Diffuse Idiopathic Skeletal Hyperostosis on the Occurrence of Thoracolumbar Vertebral Fragility Fractures at Different Ages

Study DesignRetrospective Case control Study.ObjectivesTo analyze the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the occurrence of new thoracolumbar vertebral fragility fractures (VFFs) at different ages.MethodsA retrospective analysis of 564 patients, including 189 patients who presented with new-onset thoracolumbar VFFs and 375 patients without spinal fractures, was performed in 4 age groups (50-59 years, 60-69 years, 70-79 years, and 80+ years). DISH was diagnosed based on computed tomography findings, and the Mata score of each disc space level combined with the maximum number of consecutive ossified segments (MNCOS) for each patient was recorded. Data were compared between the fracture and control groups, and odds ratios (ORs) were calculated for each of the 4 age groups using logistic regression.ResultsBoth the crude ORs and the adjusted ORs of DISH for VFFs decreased with age, with statistical significance shown in the 50-59 years group (crude OR = 4.373, P = 0.017; adjusted OR = 7.111, P = 0.009) and the 80+ years group (crude OR = 0.462, P = 0.018; adjusted OR = 0.495, P = 0.045). The Mata scores and the MNCOS were significant risk factors for VFFs (P < 0.05) in the 50-59 years group, but they were protective factors in the 80+ years group, which was more significant in the T11/12-L5/S1 subsegment.ConclusionsThe effect of DISH on the occurrence of thoracolumbar VFFs is complex, and in patients above 50 years, it changes from a risk factor to a protective factor with increasing age.

Relationship between diffuse idiopathic skeletal hyperostosis and lumbar paravertebral muscle fat infiltration: a CT-based retrospective study

PURPOSE

Plentiful evidence points to a significant correlation between paravertebral muscles and spinal diseases. Yet, no reports are available detailing the association between paravertebral muscle status and diffuse idiopathic skeletal hyperostosis (DISH). The purpose of this retrospective study was to assess the link between paravertebral muscle area as well as fat infiltration and DISH based on computer tomography.

METHODS

Data were obtained from patients with acute vertebral fractures who presented to a single spine center. All participants had whole spine lateral x-ray radiography for DISH diagnosis. Those with a history of spinal disease, fusion surgery, or tumors were excluded. Patients with or without DISH were propensity-matched by age, sex, and body mass index (BMI). Appropriate Mann-Whitney U-tests or independent t-tests were performed to evaluate the correlation between muscle area or fat infiltration of the L3 level paravertebral muscles and DISH.

RESULTS

A total of 114 DISH and 114 non-DISH patients were assessed. The fat infiltration in the paravertebral muscles was remarkably higher in the DISH group than in the non-DISH (p < 0.05), whereas there was no statistical difference in the muscle area of the two (p > 0.05).

CONCLUSION

In conclusion, the fat infiltration of the paravertebral muscles was significantly associated with DISH.

The prevalence of vertebral fractures in diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: A systematic review and meta-analysis

Background

Subjects with ankylosing spinal disorders, including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) are more prone to vertebral fractures and frequently present with neurological deficit compared to the patients without an ankylosed spine. Moreover, prevalent vertebral fractures are an important predictor for subsequent fracture risk. However, the pooled fracture prevalence for DISH is unknown and less recent for AS. We aimed to systematically investigate the prevalence and risk of vertebral fractures in DISH and AS populations.

Methods

Publications in Medline and EMBASE were searched from January 1980 until July 2023 for cohort studies reporting vertebral fractures in AS and DISH. Data on prevalence were pooled with random effects modeling after double arcsine transformation. Heterogeneity was assessed with I2 statistics and we performed subgroup analysis and meta-regression to explore sources of heterogeneity.

Results

We included 7 studies on DISH (n = 1,193, total fractures = 231) with a pooled vertebral fracture prevalence of 22.6% (95%CI: 13.4%-33.4%). For AS, 26 studies were included (n = 2,875, total fractures = 460) with a pooled vertebral fracture prevalence of 15.2% (95%CI: 11.6%-19.1%). In general, fracture prevalence for AS remained similar for several study-level and clinically relevant characteristics, including study design, diagnostic criteria, spine level, and patient characteristics in subgroup analysis. AS publications from 2010 to 2020 showed higher fracture prevalence compared to 1990 to 2010 (18.6% vs. 11.6%). Fractures in DISH were most common at the thoracolumbar junction, whereas for AS, the most common location was the mid-thoracic spine.

Conclusions

Vertebral fractures are prevalent in AS and DISH populations. Differences in fracture distribution along the spinal axis exist between the 2 disorders. Additional longitudinal studies are needed for incident fracture assessment in patients with ankylosing spinal disorders.