Pasquale Ambrosino, Domenico Scrutinio, Maurizio De Campi, Enzo Miniero, Roberto Formisano, Giorgio Alfredo Spedicato, Gian Luca Iannuzzi, Nicola Pappone
Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
DOI: 10.2340/16501977-2658

Objective: To assess the prevalence of diffuse idiopathic skeletal hyperostosis and its relationship with vascular risk factors among patients with congestive heart failure.
Design: Population-based cross-sectional study.
Participants: A total of 584 consecutive patients admitted to a Rehabilitative Cardiology Unit.
Methods: Chi-square Automatic Interaction Detector (CHAID) decision tree analysis was used to build a predictive model.
Results: The mean age (standard deviation) of the study population was 68. 1 years (standard deviation 12. 3), and 77. 7% of the subjects were men. The overall prevalence of diffuse idiopathic skeletal hyperostosis in the cohort was 49. 8%. Logistic regression analysis showed that age was a predictor of diffuse idiopathic skeletal hyperostosis (odds ratio: 1. 034; 95% confidence interval 1. 021–1. 047, p < 0. 001), with increasing odds ratios for increasing age tertiles.
The CHAID prediction model identified 2 age “buckets”: ≤ 69 and > 69 years. Patients > 69 years had a diffuse idiopathic skeletal hyperostosis prevalence of 60. 1%, compared with 39. 2% among those ≤ 69 years. Notably, body mass index was a predictor of diffuse idiopathic skeletal hyperostosis in this younger subset of patients (p = 0. 028), with 2 body mass index “buckets”, ≤ 23. 3 and > 23. 3 kg/m2, the latter showing more than twice the prevalence of diffuse idiopathic skeletal hyperostosis (43. 2% vs 20%).
Conclusion: Diffuse idiopathic skeletal hyperostosis is extremely frequent among patients with congestive heart failure, with age and body mass index being the strongest predictors.

Diffuse idiopathic skeletal hyperostosis (also known as Forestier’s disease) is a systemic condition with a wide spectrum of clinical manifestations. Patients with diffuse idiopathic skeletal hyperostosis often experience pain, stiffness, loss of range of motion, and even difficulty breathing or swallowing. As a consequence, the presence of such disabling symptoms may interfere with activities of daily living and significantly reduce perceived quality of life. Moreover, the ankylosed spine in patients with diffuse idiopathic skeletal hyperostosis is prone to unstable fractures, thus exposing patients to a considerable risk of secondary spinal cord injury. This study found an exceptionally high prevalence of diffuse idiopathic skeletal hyperostosis among patients with congestive heart failure who were undergoing cardiac rehabilitation, particularly in obese and older individuals. Given the risk of spinal fractures, even after low impact trauma, and of severe disability, the presence of diffuse idiopathic skeletal hyperostosis should always be investigated in patients with congestive heart failure who report stiffness of the spine or chronic back pain, especially in those undergoing exercise-based activities.