Prevalence of diffuse idiopathic skeletal hyperostosis in Budapest, Hungary

C. Kiss, T. W. O'Neill1, M. Mituszova, M. Szilágyi, J. Donáth and Gy. Poór

National Institute of Rheumatology and Physiotherapy, Budapest, Hungary and
1 ARC Epidemiology Research Unit Manchester, UK

SIR, Diffuse idiopathic skeletal hyperostosis (DISH) is a musculoskeletal disease of unknown aetiology, characterized by the presence of ligamentous ossification of the anterolateral aspect of the spinal column. The condition is recognized in many parts of the world, including North and South America, Europe, the Middle East, Africa, Asia and Australia [15]. There are, however, relatively few population-based studies concerning the population prevalence of the disease and, to our knowledge, no studies from central Europe [1, 2]. Such data are important in order to characterize the burden of the disease. The aim of our study was to determine the prevalence of DISH in a population sample of men and women in Budapest, Hungary.

Men and women were recruited from a health register covering 120 000 inhabitants in the third district of Budapest. Stratified random sampling was used, with a target of recruiting 50 men and women in each of six 5-yr age groups (50–54 yr, 55–59 yr, 60–64 yr, 65–69 yr, 70–74 yr and >=75 yr of age). The selected subjects were invited by letter to attend, and to complete a lifestyle questionnaire and undergo lateral radiographs of the dorsal and lumbar spine. Radiographs were taken using a standard protocol, which specified aspects of patient positioning and radiographic technique. All of the radiographs were evaluated for the presence of DISH by an experienced radiologist (M.Sz.) and a rheumatologist (C.K.) using the modified Resnick criteria [1]. In the modified criteria, individuals with ligamentous calcification continuously overbridging two or more intervertebral spaces (rather than the three as suggested by Resnick) were classified as DISH [6].

In total, 307 men (mean age 64±14.9 yr) and 328 women (mean age 64.3±14.1 yr) were recruited. Eighty-four (27.3%) men and 42 (12.8%) women had DISH according to the modified Resnick criteria. The prevalence of DISH increased with age: in men, from 10% at age 50–54 yr, rising to 36% at age >=75 yr; and in women, from 1.9% at age 50–54 yr, rising to 26% at age >=75 yr. With increasing age, the male to female ratio decreased gradually.

The prevalence of DISH reported here is higher than in previous population studies in Finland. It is similar though to results from a more recent large scale survey in the USA, based on assessment of lateral chest X-rays, where the prevalence of DISH among men aged >=50 yr was 25%, and in women it was 15% [7]. In the latter study, the frequency appeared higher in Caucasians than in blacks, native Americans and Asians, suggesting racial differences in occurrence.

Our data are consistent with most previous reports suggesting a higher prevalence of DISH in men than in women. The aetiology of DISH is unknown, although there is an association with metabolic factors including diabetes mellitus and obesity. Any aetiological model, however, needs to be consistent with the higher frequency in men and the relatively high prevalence of the disease in central Europe.

In summary, our data highlight the frequent occurrence of the condition in Budapest, particularly in men, and the rise in frequency of the disease with age.

Notes

Correspondence to: C. Kiss, National Institute of Rheumatology and Physiotherapy, Frankel Leo Street 38–40, Budapest, Hungary. Back

References

  1. Julkunen H, Heinonen OP, Knekt P, Maatela J. The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol1975;4:23–7.[Medline]
  2. Henrard JC, Bennett PH. Etude épidemiologique de l'hyperostose vertébrale. Enquête dans une population adults d'indiens d'Amérique. Rev Rhum Mal Osteoartic1973;40:581–91.[Medline]
  3. Bloom RA. The prevalence of ankylosing hyperostosis in a Jerusalem population—with description of a method of grading the extent of the disease. Scand J Rheumatol1984;13:181–9.[ISI][Medline]
  4. Cassim B, Mody G, Rubin D. The prevalence of diffuse idiopathic skeletal hyperostosis in African blacks. Br J Rheumatol1990;29:131–2.[ISI][Medline]
  5. Tsukamoto Y, Onitsuka H, Lee K. Radiological aspects of DISH in the spine. Am J Roentgenol1977;129:913–8.[ISI][Medline]
  6. Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestation. Radiology1975;115:513–24.[Abstract]
  7. Weinfeld RM, Olson PN, Maki DD, Griffiths HJ. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skeletal Radiol1997;26:222–5.[ISI][Medline]
Accepted 13 May 2002





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