Diffuse idiopathic skeletal hyperostosis in the oncologic population: a cross-sectional analysis of 1053 patients

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterized by ligamentous ossification along the spine. While its prevalence has been well described in the general population, data on its occurrence in oncology patients remain limited. This study aimed to assess the prevalence and distribution of DISH and early-phase DISH in newly diagnosed cancer patients undergoing initial staging with Computed Tomography (CT).

In this retrospective cross-sectional study, 1053 adult oncology patients who underwent thoraco-abdominopelvic CT for initial staging were evaluated. DISH and early-phase DISH were diagnosed using established radiologic criteria. Vertebral body densities were measured, and associated extraspinal enthesopathies and ligamentous ossifications were documented.

DISH was present in 30.3 % of patients, including 13.8 % with established DISH and 16.5 % with early-phase DISH. Prevalence was higher in older patients and males (p < 0.01). Notably, renal (43.2 %), gastric (37.5 %), and colorectal (33.7 %) cancers demonstrated significantly higher DISH rates, whereas esophageal cancer showed a lower prevalence (13.4 %). DISH was associated with decreased vertebral bone density and frequent extraspinal enthesopathies. No significant correlations were found with BMI, diabetes, or hypertension.

DISH is common among oncology patients and often coexists with extraspinal enthesopathies and reduced bone density. These findings suggest possible shared pathogenic mechanisms and underscore the importance of further studies exploring the relationship between DISH and malignancy.