Link Between Severe Obesity and DISH-Related Spinal Changes Identified

A recent study published in The Journal of Rheumatology has established a significant association between severe obesity and radiographic changes linked to diffuse idiopathic skeletal hyperostosis (DISH) in patients suffering from metabolic syndrome (MetS). Conducted by Dr. David Kiefer, MD, from Ruhr-Universität Bochum in Herne, Germany, the research analyzed the impact of varying obesity classes on the incidence of DISH-related spinal changes among 124 MetS patients, all of whom had underlying conditions such as diabetes and hypertension and a body mass index (BMI) of 25 or higher.

The study categorized participants into four obesity classes: Class 0 (BMI 25.0-29.9), Class I (BMI 30.0-34.9), Class II (BMI 35.0-39.9), and Class III (BMI ≥ 40). Radiographic assessments of the spine and chest were performed to identify the presence of DISH-related chunky spondylophytes versus degenerative spondylophytes. The diagnosis of DISH was confirmed when spondylophytes spanned at least four contiguous vertebrae.

Findings indicated that approximately 33.9% of participants diagnosed with MetS also exhibited DISH. Notably, patients with DISH presented with a significantly higher presence of DISH-related chunky spondylophytes (p < 0.0001) and a lower incidence of degenerative spondylophytes (p = 0.04) compared to those without DISH. Furthermore, individuals classified in obesity classes II and III displayed a marked increase in DISH-related chunky spondylophytes compared to those in classes 0 and I (14.1 vs. 9.7, although the difference was not statistically significant).

The implications of these findings are substantial, suggesting that obesity may not merely serve as a comorbid condition but could actively contribute to the formation of DISH-related spinal changes. Dr. Kiefer emphasized the importance of integrating weight management into the clinical treatment of MetS patients, as effective weight control could potentially mitigate the progression of DISH-related spondylophytes.

Despite the compelling results, the study's retrospective design raises concerns about potential selection bias, and the participant cohort's specific focus on MetS patients may limit the generalizability of the findings to broader populations lacking this syndrome. The authors disclosed that the study received no financial backing and reported no conflicts of interest.

As obesity rates continue to rise globally, this study adds to the growing body of research underscoring the relationship between obesity and skeletal health, particularly in patients with metabolic syndrome. Further research is necessary to explore the underlying mechanisms linking obesity and DISH, as well as to assess the impact of targeted interventions on improving outcomes for affected individuals.