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Diffuse Idiopathic Skeletal Hyperostosis (DISH) in Type 2 Diabetes: A New Imaging Possibility and a New Biomarker

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Abstract

We performed a cross-sectional study to investigate the prevalence of Diffuse Idiopathic Skeletal Hyperostosis (DISH) through Dual-Energy X-ray absorptiometry (DXA) Vertebral Fracture Assessment (VFA) in a group of post-menopausal women with Type 2 Diabetes Mellitus (T2DM). We also explored several biomarkers of bone turnover metabolism, including Wnt pathway modulators. DXA-VFA was performed to detect the presence of DISH. Serum samples were collected from all patients at the time of study recruitment. 16 different serum biomarkers were tested between the two subgroups. Given the exploratory nature of the study, we did not adjust for multiplicity. At VFA analysis, among 96 individuals enrolled in the study 20 (20.8%) showed features of DISH. No statistically significant difference was found for BMD values, between the DISH and NO-DISH subgroups. Concerning blood biomarkers, DISH patients showed a significant difference only in the sclerostin serum levels (32 vs 35.5 pmol/L, for the DISH and NO-DISH subgroup, respectively; p = 0.010). After adjustment for confounding factors, sclerostin serum levels remained significantly lower in DISH group (p = 0.002). We demonstrated a non-negligible prevalence of DISH in a population of post-menopausal women affected by T2DM and suggested low serum sclerostin as a possible key feature associated with DISH presence. In addition, we propose DXA-VFA analysis, whose radiation dose is considerably lower than conventional radiography, as a viable diagnostic and prognostic mean to obtain data not only on bone health, but also for the screening for DISH in subjects at risk.

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Availability of Data and Materials

The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

SD:

Standard deviation

BMI:

Body mass index

HbA1c:

Glycated hemoglobin

hsCRP:

High-sensitivity C-reactive protein

PTH:

Parathyroid hormone

CTX:

C-terminal cross-linking telopeptide of type 1 collagen

PINP:

Serum procollagen type 1 N-terminal propeptide

Dkk-1:

Dickkopf-1

RANKL:

Receptor activator of nuclear factor kappa-Β ligand

25(OH)D:

25-Hydroxyvitamin D

LDL:

Low-density lipoprotein

HDL:

High-density lipoprotein

HOMA-IR:

Homeostatic Model Assessment for Insulin Resistance

FFM:

Fat-free mass

FM:

Fat mass

BMD:

Bone mass density

T2DM:

Type 2 diabetes mellitus

DISH:

Diffuse idiopathic skeletal hyperostosis

DXA:

Dual-energy X-ray absorptiometry

CI:

Confidence interval

IQR:

Interquartile range

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Acknowledgements

The authors would like to thank the LURM (Laboratorio Universitario di Ricerca Medica) Research Center, University of Verona, especially Eliana Amato for performing the biochemical analyses.

Funding

Not applicable.

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Authors and Affiliations

  1. Rheumatology Unit, University Hospital of Verona, Policlinico GB Rossi, Piazzale A. Scuro, 37134, Verona, Italy

    Angelo Fassio, Giovanni Adami, Luca Idolazzi, Alessandro Giollo, Ombretta Viapiana, Emma Bosco, Maurizio Rossini & Davide Gatti

  2. Radiology Unit, University Hospital of Verona, Verona, Italy

    Riccardo Negrelli

  3. Division of Endocrinology, Diabetes and Metabolism, University Hospital of Verona, Verona, Italy

    Elena Sani, Damiano Sandri, Alessandro Mantovani & Giovanni Targher

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  1. Angelo Fassio
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  2. Giovanni Adami
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Contributions

AF, LI, DG, and MR analyzed and interpreted the data. ES, DS, and EB gathered the data. GA and RD assessed the densitometric images and RN assessed the X-rays. AF drafted the manuscript and GT, OV, AG, GA, and AM significantly contributed to the discussion. All authors revised the manuscript and approved the final draft.

Corresponding author

Correspondence to Angelo Fassio.

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Conlfict of interest

Angelo Fassio reports personal fees from Abiogen, Novartis, and Neopharmed, outside the submitted work. Luca Idolazzi reports personal fees from Eli-Lilly, Merck Sharp & Dohme, Novartis, Sanofi, Celgene, and UCB outside the submitted work. Maurizio Rossini reports personal fees from AbbVie, Abiogen, Eli-Lilly, Merck Sharp & Dohme, Novartis, Sanofi, and UCB, outside the submitted work. Davide Gatti has received advisory board honoraria, consultancy fees, and/or speaker fees from Abiogen, Celgene, Eli-Lilly, Neopharmed-Gentili, Pfizer, and UCB. All other authors do not have anything to disclose.

Ethical Approval

The study was conducted within the protocol 1483CESC approved by our local Ethics Committee, in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all participants included.

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Fassio, A., Adami, G., Idolazzi, L. et al. Diffuse Idiopathic Skeletal Hyperostosis (DISH) in Type 2 Diabetes: A New Imaging Possibility and a New Biomarker. Calcif Tissue Int 108, 231–239 (2021). https://doi.org/10.1007/s00223-020-00768-2

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