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The signs and symptoms you experience depend on which part of your body is affected by diffuse idiopathic skeletal hyperostosis. The upper portion of your back (thoracic spine) is most commonly affected. Signs and symptoms may include:

• Stiffness. Stiffness may be most noticeable in the morning.
• Pain. You may feel pain when someone presses on the affected area. Not everyone with diffuse idiopathic skeletal hyperostosis experiences pain.
• Loss of range of motion. Loss of lateral range of motion may be most noticeable. You flex your spine laterally when you do side stretches, for example.
• Difficulty swallowing or a hoarse voice. You may experience these symptoms if you have diffuse idiopathic skeletal hyperostosis in your neck (cervical spine).

When to see a doctor
Make an appointment with your doctor if you have persistent pain or stiffness in any joint or in your back.

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It isn't clear what causes diffuse idiopathic skeletal hyperostosis, but doctors have some idea of what can increase your risk of the condition. Risk factors include:

• Certain medications. Long-term use of medications called retinoids, such as isotretinoin (Accutane, others), that are similar to vitamin A can increase your risk of diffuse idiopathic skeletal hyperostosis. It isn't clear whether high intake of vitamin A increases your risk, however.
• Sex. Men are much more likely to develop diffuse idiopathic skeletal hyperostosis.
• Older age. Diffuse idiopathic skeletal hyperostosis is most common in older adults, especially in people older than 50.
• Diabetes and other conditions. People with type 2 diabetes may be more likely to develop diffuse idiopathic skeletal hyperostosis than are those who don't have diabetes. Other conditions that may raise insulin levels in your body may also increase your risk, including hyperinsulinemia, prediabetes and obesity.

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People with diffuse idiopathic skeletal hyperostosis are at risk of certain complications, such as:

• Disability. Loss of range of motion in the affected joint can make it difficult to use that joint. For instance, diffuse idiopathic skeletal hyperostosis in your shoulder can make it difficult and painful to use your arm.
• Difficulty swallowing. Bone spurs associated with diffuse idiopathic skeletal hyperostosis in the neck (cervical spine) can put pressure on your esophagus, making it difficult to swallow. The pressure from bone spurs can also cause a hoarse voice or difficulty breathing while you're asleep (sleep apnea). In rare circumstances this can become serious and may require surgery to remove the bone spurs.
• Paralysis. Diffuse idiopathic skeletal hyperostosis that affects the ligament running up the outside of your spine (posterior longitudinal ligament) can put pressure on your spinal cord. Spinal cord compression may result in a loss of feeling and paralysis.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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If you have signs and symptoms common to diffuse idiopathic skeletal hyperostosis, make an appointment with your family doctor or a general practitioner. After an initial evaluation, your doctor may refer you to a specialist such as a rheumatologist, physiatrist, orthopedic surgeon or neurologist.

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you've been experiencing, and for how long.
• Write down your key medical information, including any other conditions with which you've been diagnosed as well as the names of all medications, vitamins or supplements that you're taking.
• Write down any possible causes of injury to the affected area.
• Write down questions to ask your doctor.

Preparing a list of questions ahead of time will help you make the most of your appointment. For diffuse idiopathic skeletal hyperostosis, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What tests do I need?
• Which treatment approach do you recommend?
• What self-care steps can help me manage this condition?
• Do I need to follow any activity restrictions?
• How often will you see me for follow-up visits?
• If the first treatment approach doesn't work, what will you recommend next?
• I have these other health conditions. How can I best manage them together?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
A doctor who sees you for signs and symptoms common to diffuse idiopathic skeletal hyperostosis is likely to ask you a number of questions, including:

• What are your symptoms, and when did you first notice them?
• Have your symptoms gotten worse over time?
• Are your symptoms worse in the morning?
• Do you have any difficulty moving the affected joint?
• Do your symptoms include difficulty swallowing?
• What, if anything, seems to improve your symptoms?
• Have you been diagnosed with any other medical conditions?
• What medications are you currently taking, including prescription and over-the-counter drugs as well as vitamins and supplements?
• Have you previously taken any long-term, prescribed medications, such as for acne or other skin conditions?
• Have you ever had an accident or injury that might have caused trauma to the affected area?

What you can do in the meantime
If you're in pain, try applying heating pads or cold packs. Over-the-counter pain relievers also may help. Acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), may work well. But avoid NSAIDs if you have a history of allergy to these medications or a history of gastrointestinal bleeding.

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To determine whether you have diffuse idiopathic skeletal hyperostosis, your doctor may begin with a physical examination. He or she will press lightly on your spine and joints to feel for abnormalities. Any pain you experience from the pressure on your spine may be a clue to the diagnosis. Diffuse idiopathic skeletal hyperostosis may cause pain at the point where the affected tendon or ligament attaches to a bone. Your doctor may be able to detect bone spurs.

Your doctor also will order imaging tests to help with the diagnosis. Tests that may be used include:

• X-rays. Your doctor will order X-rays to confirm a diagnosis of diffuse idiopathic skeletal hyperostosis.

  X-rays may show calcification along the bones that make up your spine (vertebrae). The calcification has a distinct appearance that doctors sometimes refer to as cascading or flowing. Some compare the appearance to that of candle wax dripping and oozing down your spine.

• Computerized tomography (CT) and magnetic resonance imaging (MRI). These tests can rule out conditions that may cause similar signs and symptoms, such as ankylosing spondylitis.

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While there's no cure for diffuse idiopathic skeletal hyperostosis, there are steps you can take to reduce pain and stiffness if you're experiencing those symptoms. In many cases, treatment may not be necessary. However, if you experience symptoms of diffuse idiopathic skeletal hyperostosis, your doctor may recommend treatments to control pain and maintain range of motion in your affected joints.

Treatment for pain
Treatment for pain caused by diffuse idiopathic skeletal hyperostosis is similar to that of other joint ailments. Your doctor may recommend acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). More severe pain can be treated with corticosteroid injections.

Treatment for stiffness
Physical therapy can reduce the stiffness associated with diffuse idiopathic skeletal hyperostosis. Exercises may also increase your range of motion in your joints. Ask your doctor about specific exercises you can do. He or she may refer you to a physical therapist for further guidance.

Surgery
Surgery may be required in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who experience difficulty swallowing due to large bone spurs in the neck may need surgery to remove the bone spurs. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.

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To help you manage any pain and stiffness you experience with diffuse idiopathic skeletal hyperostosis, try these self-care measures:

• Exercise regularly. Regular aerobic exercise, such as walking or swimming, can increase your endurance, keep your body more nimble and help you cope with diffuse idiopathic skeletal hyperostosis. Talk with your doctor before you start an exercise program.
• Apply heat. Use a heating pad on areas of your body that are affected by diffuse idiopathic skeletal hyperostosis to reduce pain. Set the heating pad at a low setting so that it's warm, not hot, to reduce the risk of burns.
• Apply cold packs. For some people, cold packs relieve pain more effectively than heating pads. Alternating heat and cold can be effective for others.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.