Vitality Unleashed: The Functional Medicine Podcast

The Silent Bone Builder: Understanding DISH

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 88

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Could your persistent back stiffness be signaling something more significant about your overall health? Diffuse Idiopathic Skeletal Hyperostosis (DISH) might be the missing piece in your health puzzle—a condition where extra bone forms along the spine and other joints, creating flowing bridges between vertebrae while preserving disc spaces.

Despite affecting a substantial portion of the population, particularly men over 50, DISH frequently goes undiagnosed. What makes this condition particularly noteworthy isn't just its effects on bone—it's the remarkable connections to metabolic health. Our deep dive reveals the strong associations between DISH and conditions like diabetes, obesity, metabolic syndrome, and cardiovascular issues. This suggests that DISH isn't merely a bone disorder but potentially another manifestation of broader metabolic dysfunction.

Perhaps most concerning is the dramatically increased risk of spinal fractures in people with DISH. A spine stiffened by these bony bridges becomes brittle, functioning more like a single long bone than a flexible column. The result? Up to four times higher fracture risk, even from minor trauma, with a substantially greater chance of spinal cord injury. We also explore how DISH in the cervical spine can occasionally cause swallowing or breathing difficulties, and how it might impact lung function through reduced chest wall mobility.

The exact cause of DISH remains elusive—hence the "idiopathic" in its name—though we examine fascinating theories involving genetics, blood vessel patterns, and metabolic factors. While specific treatments to halt bone formation don't yet exist, understanding this condition allows for better symptom management and more comprehensive health monitoring.

If you're experiencing unexplained spinal stiffness, particularly if you have risk factors for metabolic syndrome, this episode provides crucial insights that could change your approach to bone and overall health. Visit LifeWellMD.com or call 561-210-9999 to explore how our comprehensive approach to health and longevity can help address conditions like DISH and their broader implications for your wellness.

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

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Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

Speaker 1:

Imagine this you could be walking around with a condition affecting your bones, something that might even increase your risk of fractures and links to things like heart issues, diabetes, and you might not even know its name. Talking about diffuse idiopathic skeletal hyperostosis, or DISH, it's a mouthful right.

Speaker 2:

It really is Dish.

Speaker 1:

It's a mouthful right, it really is. But this deep dive is going to unpack what you need to know about this often missed condition and why it could be relevant to your long-term health.

Speaker 2:

Exactly. We're taking a close look at dish today. It's basically a condition where extra bone forms in the body. What makes dish distinct? Well, it's the way it often shows up along the spine. You get at least three bony bridges forming along the front and the side of the vertebrae.

Speaker 1:

Bony bridges.

Speaker 2:

Yeah, but it's not just the spine. This extra bone can pop up in other places too. Think shoulders, elbows, hips, knees, ankles, usually where tendons and litiments attach to the bone. Those are called emphases. So these bony bridges forming it almost sounds like your body's trying to fuse itself. Maybe In a way, yeah, but it's not necessarily a good thing. This extra bone, as we'll explore understanding dish, is really important. It's linked to a higher chance of spinal fractures for one Right and, maybe surprisingly, it has strong connections to things like metabolic syndrome.

Speaker 1:

Which includes high blood pressure cholesterol issues.

Speaker 2:

Exactly, and potential issues with your heart, even your breathing Wow. And that's why we at LifeWellMD we're an innovative clinic down here in Florida specializing in health, wellness and longevity we feel it's just so important to bring conditions like DISH into the light.

Speaker 1:

Makes sense.

Speaker 2:

We're really dedicated to helping you understand your body's signals, you know, and take proactive steps towards better health. If you're curious to learn more about how we do things, you can always visit us at LifeWellMDcom.

Speaker 1:

Good to know, so let's start with that name, then Diffuse Idiopathic Skeletal Hyperostosis. It kind of tells a story, doesn't it?

Speaker 2:

It does. Yeah, it's evolved quite a bit over time.

Speaker 1:

I think it started with something more basic.

Speaker 2:

That's right. Initially it was often just called hyperostosis in the spinal column Pretty straightforward, it's true too. Then later it became known as Forrester's disease, named after the doctors who really brought attention to it back in the mid-20th century. Okay, and the term D-SAGE, the one we use most commonly now, that came about in the mid-70s, coined by researchers Resnick and colleagues who were looking for a more precise description.

Speaker 1:

And if you break down desage, each part of the name gives you a clue.

Speaker 2:

Exactly.

Speaker 1:

Diffuse suggests it's widespread, not just one spot. Idiopathic tells us. The exact cause is still well a puzzle.

Speaker 2:

It's all unknown, yeah.

Speaker 1:

Skeletal points to the bones, obviously, and hyperostosis just means extra bone growth. Yep, same. So DSH is all right there in the name. Now, how do doctors actually go about diagnosing this? What are they looking for?

Speaker 2:

Well, the real breakthrough in diagnosing DSH came back in 1976. That was with Resnick and Nuwayama. They established radiographic criteria things you can actually see on an x-ray and their criteria have really been the cornerstone for how disease is identified, especially in research settings. The first key thing is seeing flowing calcification and ossification.

Speaker 1:

Flowing Like liquid bone almost.

Speaker 2:

Kind of yeah, along the front and side, the anterolateral aspects of at least four vertebrae, one after the other in a row. Think of it like a smooth, continuous pour of extra bone linking these vertebrae together.

Speaker 1:

Okay, so not like sharp individual bone spurs, but these smoother flowing connections, and it has to be at least four vertebrae.

Speaker 2:

At least four according to those original criteria. Then the second part is that even with all this extra bone, the spaces between the vertebrae where the discs live, they should still look relatively normal in height.

Speaker 1:

Right, so the discs aren't collapsing like you might see in typical arthritis or degeneration.

Speaker 2:

Exactly, and they shouldn't see other big signs of degenerative disc disease either, like gas pockets in the discs or significant hardening of the vertebral edges.

Speaker 1:

Okay, so the disc spaces are still holding up, acting like spacers between those bony bridges. And the third piece. What's the last part of the criteria?

Speaker 2:

The final criterion is the absence of fusion in the small joints at the back of the spine. Those are the epiphysial joints, or facet joints, and no significant issues like erosion, sclerosis or fusion in the sacroiliac joints. That's where your spine connects down to your pelvis.

Speaker 1:

So these criteria really help doctors tell Dish, apart from other things that cause spinal stiffness or fusion, maybe like ankle-losing spondylitis?

Speaker 2:

Precisely. It's like having a specific checklist to identify dish on an x-ray Got it? But it's important to remember. These criteria are developed to spot more advanced cases, particularly in the spine.

Speaker 1:

Right.

Speaker 2:

They might not always pick up on earlier stages or dish that's mainly affecting other parts of the body, like the elbows or heels.

Speaker 1:

Okay.

Speaker 2:

And actually over the years researchers have proposed lots of different diagnostic criteria. I think maybe around two dozen in total.

Speaker 1:

Two dozen, Wow. That's a lot of different ways to look at it. What were the main differences between them?

Speaker 2:

Well, the most consistent thing across almost all of them was that new bone bridging on the front of the vertebrae. That was pretty central Okay.

Speaker 1:

But they differed in the details.

Speaker 2:

Yeah.

Speaker 1:

Like exactly how many vertebrae needed to be involved? How complete did those bony bridges have to be? How well preserved did the discs and other spinal joints need to look? Did they include bone growth and other joints? You know peripheral and thesopathies, and even how they looked just x-rays or incorporating newer imaging like CT scans.

Speaker 2:

It really sounds like the field is still maybe fineuning the best way to define and diagnose DSH, especially in earlier stages or when it shows up outside the spine.

Speaker 1:

Absolutely, and in rheumatology we often distinguish between classification criteria and diagnostic criteria.

Speaker 2:

What's the difference there?

Speaker 1:

Well. Classification criteria are usually straighter. They're used in research to make sure everyone's studying a very similar, specific group of patients. Diagnostic criteria are what doctors use day to day in the clinic to identify the condition in an individual patient.

Speaker 2:

The resonant criteria are great for research because they're very specific. They really nail down classic DISH. But they might be too strict sometimes for clinical use. They could potentially exclude someone who has DISH but maybe also has some signs of osteoarthritis in those facet joints, for instance. They might be too strict sometimes for clinical use. They could potentially exclude someone who has DISH but maybe also has some signs of osteoarthritis in those facet joints for instance.

Speaker 1:

So the research definition is super precise for studying DISH alone, but in the real world, doctors need to look at the whole picture for each patient. Okay, so we know what DISH looks like and how it's generally diagnosed, but what's actually causing this extra bone to grow? What's going?

Speaker 2:

on inside the body. That is the million dollar question and the honest answer is the exact cause. The pathogenesis of DISH is still unknown.

Speaker 1:

Really Still idiopathic.

Speaker 2:

Still idiopathic. We have a lot of clues, a lot of associations we'll talk about, but the full picture, it remains elusive.

Speaker 1:

All right, let's dive into those clues then. What does the extra bone actually look like up close under a microscope?

Speaker 2:

Microscopically. Yeah, you see, these bony bridges are directly connected to the existing bone of the vertebrae. It's mostly cortical bone, that dense outer layer.

Speaker 1:

The hard stuff.

Speaker 2:

The hard stuff, yeah, but there's also some cancellous bone, the more spongy inner part, and interestingly they've also found woven bone.

Speaker 1:

Woven bone. What does that mean?

Speaker 2:

Woven bone suggests it's an active process. It's often laid down quickly during periods of bone formation or remodeling. Think of it like the initial scaffolding that gets refined into stronger lamellar bone over time. So its presence tells us this isn't just old static bone. There's ongoing activity.

Speaker 1:

So it's not just a one-time event. It's an ongoing process of bone formation and change and since this often happens where tendons and ligaments attach those emphases you mentioned, what does that suggest about potential causes?

Speaker 2:

Well, that location really points towards a complex mix of factors probably influencing the cells in those areas. You've got fibroblasts making connective tissue, chondrocytes, which are cartilage cells plus the collagen fibers and the mineral matrix. So researchers are looking at a combination of things genetic predisposition, maybe vascular factors, blood supply, metabolic influences which seem really key, and even mechanical stress on those attachment points.

Speaker 1:

It sounds like a lot of potential players in this game. Now we touched on some things that seem more common in people with DISH. What do we know about the bigger picture, the epidemiological associations, the risk factors?

Speaker 2:

Yeah, we've definitely identified several strong links. The most notable ones are increasing age being, male obesity, high blood pressure and having conditions like diabetes and metabolic syndrome.

Speaker 1:

Let's start with age. That seems like a pretty consistent factor across the board, doesn't it?

Speaker 2:

Absolutely. Study after study looking at how common DISH is in different populations shows a clear trend the older you get, the more likely you are to have DISH.

Speaker 1:

Right.

Speaker 2:

When researchers compare the average age of people with DISH to those without the DISH, group is consistently older, and if you look decade by decade, the prevalence just keeps climbing significantly.

Speaker 1:

So it's definitely a condition that becomes much more common as we age. What about gender? You mentioned being male is a factor.

Speaker 2:

Yes, numerous studies have found a much higher prevalence of DISH in men compared to women. Some studies report ratios as high as like seven men for every one woman with this dish.

Speaker 1:

Wow, seven to one.

Speaker 2:

Yeah, although it's worth noting some of those studies maybe had smaller numbers or didn't fully account for other factors, but the trend is definitely there and, interestingly, it seems, this gap between men and women widens even more as people get older.

Speaker 1:

That's quite a difference. Okay, now let's talk about wheat. There seems to be a strong connection with obesity.

Speaker 2:

That's right. Pretty much every study that has looked at the relationship between DISH and body mass index, bmi, has found that people with DISH tend to have a higher BMI. And what's really telling is even when researchers use statistics to adjust for other things that might be linked like age, this connection between DISH and higher BMI stays significant.

Speaker 1:

So it's not just that older people might be heavier and have DISH. There seems to be a more direct link. What about high blood pressure?

Speaker 2:

Hypertension yeah, also seen more often in people with DISH compared to those without. Now, not every single study has shown this to be statistically significant, but several have, and a couple even found that the systolic blood pressure in the top number tends to be a bit higher in individuals with DISH-E.

Speaker 1:

Okay, another piece pointing towards metabolic health.

Speaker 2:

Yeah.

Speaker 1:

And diabetes Diabetes mellitus?

Speaker 2:

yes, Several studies have found that it's significantly more common in patients with DISH. Others have also seen a trend towards higher rates in the DISH group, even if the statistics didn't quite reach significance in their particular study.

Speaker 1:

So again, it seems like DISH might travel in the same circles as these metabolic issues. You mentioned the broader concept too, metabolic syndrome.

Speaker 2:

Yes, exactly. When you look at metabolic syndrome as a whole, that cluster of risk factors. When you look at metabolic syndrome as a whole, that cluster of risk factors increased waist size, high triglycerides, low good cholesterol, hdl high blood pressure, high fasting blood sugar.

Speaker 1:

Right.

Speaker 2:

There's a strong correlation with DSH. Some of those individual parts seem more strongly linked than others. For example, higher triglycerides are more common but maybe not always statistically significant on their own. But increased waist circumference, higher blood pressure and elevated fasting glucose those seem to be key drivers of this association between metabolic syndrome and Dietsch.

Speaker 1:

It's really starting to paint a picture, isn't it? Dish seems to be more than just a bone thing. It might be another sign pointing towards these underlying metabolic problems. What about the heart and blood vessels directly?

Speaker 2:

That's interesting too. While general cardiovascular events like heart attacks or strokes haven't consistently been reported as much more common in dish, some specific findings are quite suggestive. For instance, hardening of the aorta aortic sclerosis has been found significantly more often in the DISH group, even after adjusting for age and sex. Similarly, calcium buildup calcifications in the aorta and also in the coronary arteries that supply the heart muscle that's also seen more frequently in people with a DISH, even when you account for things like age, bmi and gender. So it suggests a potential link between dish and the health of our larger blood vessels.

Speaker 1:

That's a really important connection. It makes you wonder if dish could be, I don't know, an early indicator or just part of a bigger process affecting the vascular system. What about other parts of the body, our lungs, for example?

Speaker 2:

Yeah, there's an association found between dish and lower lung volumes.

Speaker 1:

Lower lung volumes. How?

Speaker 2:

Well, the thinking is that the bone growth in the spine, especially the thoracic spine, could potentially extend to where the ribs attach. This could lead to a stiffer rib cage less able to expand fully.

Speaker 1:

Right.

Speaker 2:

And this is supported by findings of restrictive patterns on pulmonary function tests. Breathing tests in with Dishesh indicating a reduced capacity to get air in, and this could even have implications potentially increasing the risk of things like pneumonia, especially in older adults with a less mobile chest wall.

Speaker 1:

So a bone condition could actually impact how well you breathe. That's a connection most people probably wouldn't make. What about lifestyle factors like smoking or drinking? Do they play a role?

Speaker 2:

Well, the findings on smoking and dishish have been pretty inconsistent across studies. Some found more smokers in the group, others didn't, so can't really draw a firm conclusion there right now. Ok, and similarly with regular alcohol consumption, after accounting for other factors, there doesn't seem to be a strong, clear link to dishish.

Speaker 1:

So, unlike the clearer links with age and metabolic factors, those lifestyle habits don't seem to have a consistent relationship.

Speaker 2:

Got it Now. There's a common idea out there, isn't there? That dish is simply the hardening, the ossification of that big ligament running down the front of our spine, the AL, the anterior longitudinal ligament. Is that what's happening?

Speaker 1:

Ah, yes, that's a really common misunderstanding. Yeah, but the evidence actually points to something different.

Speaker 2:

Oh.

Speaker 1:

When researchers have looked closely, macroscopically at spines with DISH, they found that the ALL, the ligament itself, is actually still present. It's usually in its normal position right in the midline, at the levels where there isn't any new bone growth, but where the bony bridges do form, typically on the side. The AL is often found pushed away, displaced to the side, by the new bone.

Speaker 2:

So the new bone isn't just the ligament turning into bone, it's actually forming alongside it and sort of shouldering it out of the way.

Speaker 1:

Exactly, it's forming adjacent to, and often anterior or anterolateral to, the ligament, not necessarily within it. That's a really important distinction. It is Good to clarify that. Now, what about genetics? Does this run in families?

Speaker 2:

There are definitely hints that genetics might be involved. Yes, we've seen reports of familial occurrences disease running in families, which suggests a possible inherited predisposition.

Speaker 1:

Interesting.

Speaker 2:

Also kind of an interesting side note in the veterinary world. Certain dog breeds, like boxer dogs, have a significantly higher rate of DISH than other breeds.

Speaker 1:

Boxers.

Speaker 2:

Yeah, and there's even a mouse model that researchers use which mimics some features of DISH In humans. Some preliminary studies have looked at variations, single nucleotide polymorphisms or SNPs in specific genes like KOL6A1 and FGF2 and found potential links, but this is still really early days.

Speaker 1:

So needs more research.

Speaker 2:

Definitely we need larger studies like genome-wide association studies, gwas, to really map out the genetic factors involved. But the clues are there, suggesting genetics likely plays some part.

Speaker 1:

OK, let's circle back to where this extra bone tends to form. You mentioned it's often on the front and sides and kind of asymmetrical in the mid-back, the thoracic spine. Why that specific pattern?

Speaker 2:

Yeah, that pattern is fascinating and that's where vascular factors blood vessels likely play a role. The thinking is that the new bone tends to form in areas that are away from major pulsating blood vessels like the aorta.

Speaker 1:

Oh, the big artery.

Speaker 2:

Exactly In the lower thoracic spine. The aorta usually sits slightly to the left. And guess what? The dish bone formation is often more prominent on the right side in that region. Avoiding the pulse. It seems so, and even more telling in rare cases where people have sedus inverses, where their organs are flipped. Mirror image.

Speaker 1:

Right heart on the right side, etc.

Speaker 2:

Exactly In those individuals with DISH, the bony bridges in the thoracic spine have been observed to be predominantly on the left side, the opposite of usual.

Speaker 1:

Wow, that strongly suggests the aortus pulsation influences where the bone forms, or rather where it doesn't form.

Speaker 2:

Precisely, it seems to avoid those strong pulsations.

Speaker 1:

What about the flowing nature of the bone? Does blood flow play a role there too?

Speaker 2:

Well, it's been proposed that the smaller segmental blood vessels, the ones that cross the vertebrae around the middle of the body, might somehow contribute to that flowing pattern, maybe by providing nutrients or signals.

Speaker 1:

Okay.

Speaker 2:

And the fact that the cervical spine, the neck, which doesn't have quite the same vascular setup, tends to have less of that classic, smooth flowing bone formation, might lend some support to that idea.

Speaker 1:

Interesting.

Speaker 2:

Also, some studies have found an increased number and size of the little holes in the vertebrae where blood vessels enter the nutrient foramina, and signs of increased blood muscle activity, hypervascularity in areas affected by DISH A chicken or egg. Exactly. We're still trying to figure out if this increased blood flow is a cause helping fuel the bone growth or if it's simply a consequence of the active bone formation process right, still more questions than answers there.

Speaker 1:

Now we've touched on genetics, blood vessels. Yeah, let's still have a bit deeper into the metabolic and molecular theories. We know there's that strong link with metabolic syndrome. How might that actually contribute to dish at a cellular level?

Speaker 2:

well, one hypothesis may be a bit simplistic is that in people with obesity and metabolic syndrome there might just be sort of an excess of energy available systemically, extra fuel that could potentially be channeled into this extra bone formation.

Speaker 1:

Like the body, has resources to spare for building bone.

Speaker 2:

Potentially, but of course that doesn't fully explain why it targets the spine and emphases specifically. Another related theory focuses more on the type of fat Higher amounts of visceral fat, the fat around the organs which is common in metabolic syndrome. That type of fat is metabolically active and tends to release more pro-inflammatory cytokines, these signaling molecules. So it's thought that this chronic low-level inflammation associated with visceral obesity could play a role in promoting bone growth at susceptible sites.

Speaker 1:

That makes sense. Inflammation seems to be involved in so many chronic conditions. What about specific hormones or molecules? Anything identified as a driver?

Speaker 2:

Yeah, some studies have found that levels of growth hormone GH and insulin-like growth factor 1, igf-1, both known to promote bone growth, tend to be higher in people with D-ish, and researchers are actively investigating various signaling pathways that control bone formation, things like the WANT pathway, nf-kappa B, bone morphogenetic protein 2, bmp2, prostaglandin I2, and thalin-1. These are all potential players being looked at.

Speaker 1:

A lot of molecular targets.

Speaker 2:

Yes, but again, we're still in the fairly early stages of figuring out exactly how these pathways are dysregulated or contribute specifically to dish development. Much more research needed there.

Speaker 1:

It really sounds like we're chipping away at understanding the mechanisms. Yeah, but that precise trigger for dish is still well idiopathic. Now let's shift gears a bit and talk about why this all matters to you, the listener. We mentioned DISH is often overlooked. What are the real-world clinical implications of having DISH beyond just seeing it on an x-ray?

Speaker 2:

Right, because DISH can often be present without causing obvious symptoms or because its symptoms, like stiffness, can mimic other common conditions like osteoarthritis, it often flies under the radar. However, as we've discussed, those strong links to metabolic health, cardiovascular risks and respiratory issues mean that identifying it can be clinically very important for managing your overall health and well-being.

Speaker 1:

Let's talk about the symptoms people might experience. What kind of pain or functional limitations are common?

Speaker 2:

Back pain and stiffness are definitely common complaints. Some studies show you know 70-80% of people with DISH reporting these symptoms.

Speaker 1:

Okay.

Speaker 2:

But interestingly, when researchers directly compare people with DISH to control groups without it, the findings on back pain itself can be a bit mixed. Some studies don't find a significant difference in pain levels.

Speaker 1:

Really, that's, surprising.

Speaker 2:

Yeah, and one study even suggested that maybe the extra bone, by stabilizing the spine somewhat, could potentially lead to less back pain in some individuals. Kind of a natural fusion effect perhaps.

Speaker 1:

Huh, a double-edged sword then less movement, but maybe less pain sometimes, but it sounds like flexibility is usually affected.

Speaker 2:

Yes, difficulty bending is a commonly reported issue and some research has shown that things like grip strength can be lower in people with DISH, suggesting maybe a broader impact on overall physical function, not just the spine. We really need more long-term longitudinal studies to track how pain and flexibility change over time in different stages of DISH.

Speaker 1:

Makes sense? And what about when DISH affects other joints like shoulders, elbows, ankles?

Speaker 2:

Yeah, when dish affects those peripheral joints, it can certainly cause pain, stiffness and reduced range of motion, similar to osteoarthritis, which it can also coexist with. Heel spurs are a common manifestation too, Okay, Although, again surprisingly, some studies have even reported less joint pain or stiffness in the dish group compared to controls. But those studies might have had limitations, so we need to interpret that cautiously.

Speaker 1:

So the clinical picture can be really varied. What about some of the more serious complications we touched on earlier? Difficulty, swallowing or breathing problems.

Speaker 2:

Right, because the extra bone growth in the neck, the cervical spine, happens on the front side. It can sometimes physically press on or displace the esophagus and the trachea.

Speaker 1:

The swallowing tube in the windpipe.

Speaker 2:

Exactly. This can lead to difficulty swallowing, which we call dysphagia, and in rarer but potentially serious cases, it can even cause airway obstruction or breathing difficulties.

Speaker 1:

Is that common?

Speaker 2:

Well, it's often described as rare, but a systematic review of the medical literature actually found at least 200 reported cases of dysphagia or airway issues linked to cervical dish, so it might be more prevalent than we think, perhaps under-recognized or misattributed sometimes.

Speaker 1:

Okay, and is there a treatment for that?

Speaker 2:

Yes, treatment can range from conservative measures, dietary changes, therapy, to surgery to actually remove the excess bone, the osteophytes, although there is a chance the bone could grow back over time.

Speaker 1:

That sounds like a situation where catching it early is really important. And then there's the other major concern you mentioned, the increased risk of spinal fractures. That sounds particularly worrying.

Speaker 2:

It is a significant concern. Yes, A spine that's stiffened by dish is less flexible. It acts more like a single long bone rather than a series of flexible segments.

Speaker 1:

Right.

Speaker 2:

So when there's trauma, even sometimes relatively minor trauma, the energy isn't dissipated across multiple levels, it concentrates and the spine is much more prone to fracture. The risk is estimated to be about four times higher than in a non-dish spine.

Speaker 1:

Four times higher.

Speaker 2:

And, crucially, these fractures have a much higher chance of causing spinal cord injury, up to maybe 58% in some reports.

Speaker 1:

Wow, so the stiffness makes it brittle, essentially.

Speaker 2:

In effect, yes, it leads to more unstable fracture patterns, often hyperextension-type injuries, and because the disc spaces are often bridged by bone, the fracture line frequently goes right through the vertebral body itself, rather than just the disc.

Speaker 1:

And these fractures are generally more serious in people with DISH.

Speaker 2:

Yes, they tend to be more unstable mechanically. They carry that higher risk of neurological damage and they can lead to more complications during treatment and recovery. Early diagnosis is absolutely critical to prevent further displacement of the fracture and potential worsening of any neurological injury.

Speaker 1:

But diagnosis can be tricky.

Speaker 2:

It can be. Unfortunately, there's often a delay in diagnosing these fractures. Reported delays anywhere from 19 to 41 percent of cases.

Speaker 1:

Why is that?

Speaker 2:

Well, sometimes the initial trauma might seem minimal like a simple fall from standing height. Dosing these fractures reported delays anywhere from 19 to 41 percent of cases. Why is that? Well, sometimes the initial trauma might seem minimal, like a simple fall from standing height. The patient might not have a dramatic increase in their usual baseline back pain, and standard x-rays can be really difficult to interpret because the underlying dish already makes the spine look complex.

Speaker 1:

So what's recommended?

Speaker 2:

Clinicians really need to have a high index of suspicion for fracture in anyone with known DGISH who experiences trauma, even minor trauma. Ct scans are often necessary to clearly see the fracture pattern, and a low threshold for getting an MRI is important too, especially to assess the spinal cord and ligaments. Okay, and treatment. Treatment usually involves surgery to stabilize the spine. This has been shown to improve survival and neurological outcomes. Often posterior fixation with screws and rods is preferred For certain fracture types without neurological deficit less invasive percutaneous techniques might be an option.

Speaker 1:

So if you have DISH and you have any kind of fall or accident, it's really crucial to get checked out thoroughly, being aware of this higher fracture risk.

Speaker 2:

Okay. So, given all this, what are the actual treatment options for dish itself, not just the complications.

Speaker 1:

That's the challenge, Because we don't yet fully understand the underlying cause, the pathogenesis. There's currently no specific treatment to stop the bone from forming or to reverse the process.

Speaker 2:

Right. Still waiting on understanding the idiopathic part.

Speaker 1:

Exactly so. Current management really focuses on alleviating the symptoms. This typically involves analgesics, pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs NSIIDs for pain and stiffness. Physical therapy might also play a role for maintaining function.

Speaker 2:

What about the metabolic links? Absolutely. If someone with DISH also has metabolic syndrome or diabetes or hypertension, then standard care for managing those conditions is crucial Lifestyle changes like diet and exercise and medications if needed. Addressing the metabolic side is very important for overall health.

Speaker 1:

Okay and surgery is mostly reserved for complications.

Speaker 2:

Yes, surgery really comes into play for those severe cases of symptomatic cervical dish causing swallowing or breathing problems, or for stabilizing those unstable spinal fractures we just discussed.

Speaker 1:

So it's mainly about managing symptoms, managing related conditions and dealing with complications as they arise. This really highlights the importance of just being aware of DISH, understanding the potential connections, and this is where a clinic like LifeWellMD can really play a crucial role, can it?

Speaker 2:

Absolutely. At LifeWellMD, our whole focus is on that comprehensive, personalized approach to health and longevity. We understand that conditions like DISH don't exist in a vacuum. They're often interconnected with metabolic health, cardiovascular status, overall function.

Speaker 1:

Looking at the whole person.

Speaker 2:

Exactly. Our team is really dedicated to staying at the forefront of the research, understanding these complex interactions and using that knowledge to provide truly personalized care plans. We aim not just to treat symptoms, but to understand and address the underlying factors contributing to your overall well-being.

Speaker 1:

So if you've been listening today and maybe recognize some of these things that chronic back stiffness, maybe some unexplained difficulty swallowing, or if you know you have risk factors for metabolic syndrome or heart disease it might be worth considering if DISH could be part of your picture. How can listeners get in touch with LifeWellMD to learn more?

Speaker 2:

Yeah, if you're interested in learning more about DISH or just want to discuss your individual health concerns and goals in the context of wellness and longevity, we definitely encourage you to reach out to us at LifeWellMD.

Speaker 1:

Okay.

Speaker 2:

You can visit our website, that's LifeWellMDcom, or just give us a call directly at 561-210-9999. Our team is here and happy to answer your questions and help you take that first step on your wellness journey.

Speaker 1:

Great. So just to sum things up then, disg diffuse idiopathic skeletal hyperostosis. It's a relatively common bone forming condition, often flies under the radar, but it has significant links to aging, metabolic health, cardiovascular risks and especially that increased risk of spinal fractures.

Speaker 2:

That's the core message.

Speaker 1:

Recognizing it and understanding its potential connections to other aspects of your health seems really key.

Speaker 2:

It really is, and maybe a final thought for you to consider as you think about your own health. Could that persistent stiffness you've been putting up with, or maybe even the effects of what seems like a minor injury, could they possibly be connected to something broader, an underlying condition like DHA?

Speaker 1:

Food for thought.

Speaker 2:

Being proactive, asking questions and seeking thorough evaluations when something doesn't feel right. That really empowers you to take control of your wellness journey.

Speaker 1:

Absolutely Well. Thank you for walking us through this complex condition today. It's been really insightful.

Speaker 2:

My pleasure. It's an important topic.

Speaker 1:

And for everyone listening. Thank you for joining us for this deep dive into DDAGE. And don't forget you can visit LifeWellMDcom or call 561-210-9999 to learn more about their services and take that important first step towards a healthier future.