Men With Diffuse Idiopathic Skeletal Hyperostosis at Higher Risk for Vertebral Fractures

The objective of this study was to analyze the risk of incident vertebral and nonvertebral fracture in men with DISH.

Men with diffuse idiopathic skeletal hyperostosis (DISH) or intervertebral space dysfunction (IVSD) are at increased risk for vertebral fractures. These findings from a prospective study were published in Rheumatology.

Beginning in 1995, men (N=782) who were clients of the Société de Secours Minière de Bourgogne health insurance company in France were invited to participate in the MINOS cohort study. Patients’ bone mineral density (BMD) was assessed by radiography, and they were monitored for fractures over 7.5 years.

Among the participants, 21.7% had DISH. Men with DISH were significantly older (P <.001), heavier (P <.001), had higher disc space narrowing (DSN) scores (P <.001), abdominal aortic calcification scores (P <.005), and whole-body BMD (P <.05).

Vertebral fractures were observed among 3.4% of participants and were higher among patients with DISH (6.1%) than without (2.7%; P <.05). After adjusting for all covariates, DISH was associated with increased vertebral fractures (odds ratio [OR], 2.89; 95% CI, 1.15-7.28; P <.05). Nonvertebral fractures were not associated with DISH (hazard ratio [HR], 0.72; 95% CI, 0.33-1.56; P <.41).

Among men with DISH, those with severe DSN (OR, 11.60; 95% CI, 3.25-41.46; P <.001), low spinal BMD (OR, 7.05; 95% CI, 2.29-36.80; P <.05), or endplate irregularities (OR, 6.60; 95% CI, 1.66-26.33; P <.05) were at increased risk for vertebral fracture.

Among all patients, increasing components of IVSD increased risk for vertebral fracture by an adjusted OR of 5.32 (95% CI, 2.41-11.77; P <.001) for each component.

A model including age, BMI, spine BMD, abdominal aortic calcification, prevalent vertebral fractures, and IVSD predicted vertebral fractures with an area under the receiving operator characteristic (AUC) curve of 0.794 (95% CI, 0.713-0.875).

This study was limited in that it relied on self-reported previous falls and fractures and may have included some recall bias.

The study authors concluded men with DISH were at increased risk for vertebral fractures, especially in combination with components of IVSD.


Guiot A, Estublier C, Gaude M, Szulc P, Chapurlat R. Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men. Published online November 17, 2020. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa517