Influence of Obesity on Radiographic Changes in Patients With Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification, predominantly affecting the axial skeleton. DISH is associated with obesity, diabetes mellitus, and hypertension, all included in the metabolic syndrome (MetS). The aim of this study was to investigate the prevalence of DISH in patients with MetS and the influence of obesity on spinal radiographic changes related to DISH vs degenerative changes.

Patients diagnosed with MetS were categorized into 4 obesity classes (World Health Organization criteria). Based on Resnick criteria, patients were classified as DISH or non-DISH. Radiographs were assessed for degenerative (d)-spondylophytes and DISH-related chunky (Drc)-spondylophytes, and their association with obesity was analyzed.

There were 124 patients were included, of whom 42 (33.9%) were identified as having DISH. The mean BMI was 39.8 (SD 6.3), with obesity classes distributed as follows: preobese (n = 7), obesity class I (n = 19), II (n = 38), and III (n = 60). Higher obesity classes (II and III) were significantly associated with an increased number of Drc-spondylophytes in all patients. In DISH, obesity class ≥ II was linked to a greater number of Drc-spondylophytes (14.8 [SD 10.3] vs 9.7 [SD 7.7]), whereas no association was found between obesity and d-spondylophytes. Overall, patients with DISH had fewer d-spondylophytes than those without DISH (2.7 [SD 2.7] vs 4.1 [SD 4.1]; P = 0.04).

One-third of patients with MetS were classified as having DISH. In contrast to degenerative spine disease, obese MetS classes II and III were significantly associated with radiographic spinal changes attributed to DISH.