DISH may falsely elevate bone mineral density, but it also increases the risk of spinal fractures. Energy distribution (from even a low-impact trauma) is prevented in the ankylosed spine, resulting in an increased risk of fracture.[9]Mader R, Verlaan JJ, Buskila D. Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013 Dec;9(12):741-50.
http://www.ncbi.nlm.nih.gov/pubmed/24189840?tool=bestpractice.com
Appropriate monitoring for osteoporosis with dual x-ray absorptiometry (DXA) and subsequent management is advised.[44]Diederichs G, Engelken F, Marshall LM, et al. Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone density. Osteoporos Int. 2011 Jun;22(6):1789-97.
https://link.springer.com/article/10.1007/s00198-010-1409-9
http://www.ncbi.nlm.nih.gov/pubmed/20882271?tool=bestpractice.com
A local surplus of bone in the scanning field could overestimate the true bone mineral density value on DXA.[64]Harlianto NI, Kuperus JS, Verlaan JJ. Perioperative management, operative techniques, and pitfalls in the surgical treatment of patients with diffuse idiopathic skeletal hyperostosis: a narrative review. Explor Musculoskeletal Dis. 2023;1:84-96.
https://www.explorationpub.com/Journals/emd/Article/100713
For more on the assessment and management of osteoporosis, see Osteoporosis.
Manage and monitor metabolic derangements and cardiometabolic disease on an individualized basis; this may include monitoring for, and management, of:[1]Le HV, Wick JB, Van BW, et al. Diffuse idiopathic skeletal hyperostosis of the spine: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 2021 Dec 15;29(24):1044-51.
http://www.ncbi.nlm.nih.gov/pubmed/34559699?tool=bestpractice.com
[59]Mader R. Current therapeutic options in the management of diffuse idiopathic skeletal hyperostosis. Expert Opin Pharmacother. 2005 Jul;6(8):1313-8.
http://www.ncbi.nlm.nih.gov/pubmed/16013982?tool=bestpractice.com
See Metabolic syndrome, Hypertriglyceridemia, Hypercholesterolemia, Essential hypertension, Gout, and Type 2 diabetes mellitus in adults.