5 - Etiology of Diffuse Idiopathic Skeletal Hyperostosis (DISH): The Influence of Smoking, Diabetes, and Obesity

Poster Board Number: 5
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Odd poster #s – first hour
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Abstract Body : Diffuse idiopathic skeletal hyperostosis (DISH) is a condition that results in ligamentous ossification, primarily affecting the anterior longitudinal ligament (ALL) of the spine. Although the pathogenesis of DISH is not fully understood, research suggests that pro-inflammatory states or conditions throughout the body could contribute to the development of DISH. To investigate this proposed etiology, this study aimed to examine the potential relationship between the pro-inflammatory factors of tobacco smoking, diabetes mellitus (DM), and obesity (defined in this study as a body mass index greater than 30) and the presence of DISH, using a modern, documented skeletal collection. The Southeast Texas Applied Forensic Science (STAFS) Facility is housed at the Sam Houston State University and maintains a willed body donation program that has resulted in a collection of over 400 skeletons. Donor paperwork includes a self- or family-reported medical history for each individual donated to the collection. Eighty-five individuals in the STAFS Skeletal Collection (n=62 males, 23 females; age range 50-105 years) were identified through gross morphological examination as having skeletal indications of DISH, which was determined by the presence of bridging or fusion of four or more vertebral segments along the anterior longitudinal ligament, as set forth by Resnick et al. (1978). Data on each individual’s height, weight, history of smoking, and prior diagnosis of DM were gathered from associated donor files. Data were analyzed using Chi-square goodness-of-fit tests to examine whether the observed frequency of smoking, DM, and obesity within this study’s DISH sample significantly differed from expected values, based on age-matched data on the general population of the United States, taken from the Centers for Disease Control. Odds ratios were used to assess the potential effect size on the relative risk of comorbidity with DISH. While the observed frequencies of smoking (χ2 = 156.6, p < 0.00001), DM (χ2 = 5.71, p = 0.017), and obesity (χ2 = 4.79, p = 0.029) were all significantly higher than expected for this study’s sample, only smoking significantly affected the effect size of comorbidity with DISH (odds ratio = 10.21, p < 0.0001). The findings of this study support the proposed inflammatory etiology of DISH and highlight the varying degrees that different inflammatory factors may have on the pathogenesis of DISH. These data support the need for future research to identify other pro-inflammatory factors that may play a significant role in the progression of DISH, with the goal of developing recommendations and lifestyle suggestions that clinicians can make to their patients to prevent its development and progression.