Ist die hyperostotische Spondylosis deformans eine diabetische Osteopathie?*

Metabolic factors in diffuse idiopathic skeletal hyperostosis - a review of clinical data

OBJECTIVES

We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Skeletal Hyperostosis (DISH), in order to assess associations between growth factors and DISH.

METHOD

We identified studies in our personal database and PubMed using the following keywords in various combinations: "diffuse idiopathic skeletal hyperostosis", "ankylosing hyperostosis", "Forestier's disease", "diabetes", "insulin", "obesity", "metabolic", "growth factors", "adipokines", "glucose tolerance" and "chondrocytes".

RESULTS

We were not able to do a systematic review due to variability in methodology of studies. We found positive associations between obesity (especially abdominal obesity), Type 2 diabetes mellitus, glucose intolerance, hyperinsulinemia and DISH.

CONCLUSION

Current research indicates that certain metabolic factors associate with DISH. More precise studies deriving from these findings on these and other newly identified bone-growth factors are needed.

Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis

The tendency of patients with DISH towards obesity or an adult onset of diabetes has been reflected in marked hyperinsulinaemia following glucose challenge. It is hypothesized that insulin at prolonged and high physiologic levels promotes new bone growth, particularly in the entheseal regions. These areas are also subject to various mechanical forces. The resulting new bone produces the radiological changes which characterise DISH.

Radiological criteria of industrial fluorosis

The bone radiographs of 43 potroom workers in an aluminium factory, on whom the diagnosis of industrial fluorosis had been confirmed by bone biopsy, are compared with radiographs from 18 control subjects. A higher frequency of ossification of ligament, tendon, and muscle attachments is observed among the fluoride exposed subjects. These changes increase with the bone fluoride content. The presence of hyperostosis is an important aid in the diagnosis of skeletal fluorosis. However, this radiological sign has to be complemented by clinical data and estimation of the concentration of urinary fluoride. Final confirmation of the diagnosis is obtained by bone biopsy.

Complete destruction of both femoral heads following idiopathic necrosis of the femoral heads in a diabetic patient with hyperuricemia and hyperlipoproteinemia

A practically complete destruction of both femoral heads including the femoral necks and acetabula was encountered in a 69-year-old patient with diabetes, which varied in intensity. This destruction, documented by radiographs which had been taken 8 years prior, had started as the typical picture of "idiopathic femoral head necrosis". In addition to diabetes, hyperuricemia and hyperlipoproteinemia were present at the time when the femoral head necrosis was first evidenced. One episode of gout was recorded. In recent years, following therapy, the hyperurecemia and hyperlipoproteinemia had normalized. The question is raised, as to whether or not the present radiological findings represent a complication of aseptic femoral head necrosis, combined with a diabetic arthropathy of the hip joints. Details of the angiographic findings and a spondylopathy, which have all the characteristics of a neuropathic spondylopathy, would favor this hypothesis. When associated with a diabetic condition, generalized osteoporosis and hypertrophic spondylosis of such a particular nature require special mention.

The rheumatologic manifestations of diabetes mellitus

The rheumatologic disorders associated with diabetes mellitus have been reviewed. From the evidence presented, it can be concluded that neuroarthropathy and osteolysis are definitely assoicated with diabetes. Ankylosing hyperostosis and periarthritis probably represent valid associations, and possible, but still unproven associations exist for gout, pseudogout, the carpal tunnel syndrome, osteoarthritis, Dupuytren's contracture and joint contractures. Despite the lack of a proven pathophysiologic basis these interrelationships may be clinically relevant. The discovery of one of these disorders may provide a clue to underlying glucose intolerance, and idabetics should be followed with the knowledge that they are at risk for the development of certain musculoskeletal problems.