Neurospine.  2021 Mar;18(1):109-116. 10.14245/ns.2040350.175.

Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis

  • 1Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
  • 2Keio Spine Research Group, Tokyo, Japan
  • 3Department of Orthopaedic Surgery, Ota Memorial Hospital, Oshimasho, Ota City, Japan
  • 4Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
  • 5Department of Environmental and Occupational Health, Toho University, Tokyo, Japan
  • 6Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
  • 7Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
  • 8Department of Orthopaedic Surgery, Fujita Health University, Toyoake-shi, Japan


Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome.
We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated.
Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm2; Non-DISH group, 89.0 ± 48.1 cm2; p < 0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the nonDISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0–3.7; p = 0.004).
Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.


Diffuse idiopathic skeletal hyperostosis; Metabolic syndrome; Spinal epidural lipomatosis; Body max index; Blood pressure; Spinal ankylosis
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