Osteoarthritis
Diffuse Idiopathic Skeletal Hyperostosis and Its Relation to Back Pain Among Older Men: The MrOS Study

https://doi.org/10.1016/j.semarthrit.2011.01.001Get rights and content

Objectives

To estimate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a cross-sectional study of elderly men age 65 to 100 years and to examine back and neck pain as possible correlates of DISH.

Methods

DISH was defined using Resnick's criteria and scored according to Mata on lateral spine radiographs of 298 randomly selected participants from the MrOS Study. Standardized self-reported questionnaires were used to assess the frequency and severity of back and neck pain, and the relation of these to DISH status was estimated with χ2 tests, as well as prevalence ratios and 95% confidence intervals using log-binomial regression models.

Results

DISH was observed in 126 older men (42%), increased with age (30%, 39%, 48%, and 56% for ages 65-69, 70-74, 75-79, and ≥80 respectively), and was positively associated with body mass index (BMI) (P = 0.04) and blood pressure (P = 0.02). Significantly less back pain in the past 12 months was reported among men with DISH as compared to men without (59% vs 71%, P = 0.03), which remained after adjustment for age, BMI, and blood pressure (prevalence ratios = 0.73, 95% confidence interval = 0.57-0.95). Back pain severity (P = 0.07) and frequency (P = 0.06) were also less frequent among men with DISH compared to men without, whereas reported neck pain was similar between groups (P = 0.39).

Conclusions

Among community-dwelling elderly men, DISH prevalence is high, increases with age, and is positively associated with BMI and blood pressure. Frequency of self-reported back pain over the past 12 months was lower in older men with DISH as compared to those without DISH.

Section snippets

Parent Cohort

The MrOS Study enrolled 5995 men from March 2000 through April 2002 as described elsewhere (18, 19). Briefly, recruitment occurred at 6 US academic medical centers in Birmingham AL, Minneapolis MN, Palo Alto, CA, Pittsburgh PA, Portland OR, and San Diego, CA. Men aged 65 years and older who were able to walk unassisted and had at least 1 natural hip for femoral bone density measurement were eligible for the study. The MrOS study was approved by the Institutional Review Boards at all

Characteristics

Distributions of characteristics in the study sample and in the entire cohort were similar. For example, mean ± SD age was 74 ± 6 years in both the study sample and the parent cohort; mean height was 174 ± 7 cm in both, and the study sample mean for BMI was 28 ± 4, whereas the cohort mean BMI was 27 ± 4 (data not shown). The study sample participants were mainly white (90%); approximately 60% reported a history of smoking, and most reported their health as either excellent or good (85%).

Discussion

In this cohort of community-dwelling older men not preselected for back pain or medical reasons, DISH was present in 42%, with a nearly linear association between DISH prevalence and age. Measured systolic blood pressure, current BMI, and BMI at age 25 were also positively associated with DISH. Older men with DISH were also observed to be less likely to report a history of back pain in the past year than men without DISH.

Positive associations of DISH with age and BMI (6, 7, 15, 17, 26) and

References (28)

  • C. Kiss et al.

    The prevalence of diffuse idiopathic skeletal hyperostosis in a population-based study in Hungary

    Scand J Rheumatol

    (2002)
  • R.M. Weinfeld et al.

    The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations

    Skeletal Radiol

    (1997)
  • H. Julkunen et al.

    Hyperostosis of the spine in an adult populationIts relation to hyperglycaemia and obesity

    Ann Rheum Dis

    (1971)
  • S.G. Childs

    Diffuse idiopathic skeletal hyperostosis: Forestier's disease

    Orthop Nurs

    (2004)
  • Cited by (0)

    The Osteoporotic Fractures in Men (MrOS) Study is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), and the National Center for Research Resources (NCRR) and the NIH Roadmap for Medical Research through Grants U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01 AG18197, U01 AG027810, and UL1 RR024140.

    The authors have no conflicts of interest to disclose.

    View full text