{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:40:33Z","timestamp":1779212433214,"version":"3.51.4"},"reference-count":39,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"unspecified","delay-in-days":82,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21\/00532"],"award-info":[{"award-number":["PI21\/00532"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"FEDER","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Diffuse idiopathic skeletal hyperostosis (DISH) is considered a slowly progressive condition, typically requiring a decade to achieve full radiographic development. However, some individuals exhibit accelerated ossification. This study aimed to characterise the clinical profile of these patients, referred to as Fast Ossifiers (FO).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Study nested within the Camargo Cohort, integrating cross-sectional and longitudinal data (baseline (E0), 5\u2009year (E1) and 10\u2009year assessments (E2)). Propensity Score matching was applied. FO was defined as progression of \u22652 grades in Schlapbach\u2019s Scale between consecutive assessments. We evaluated inflammation, insulin resistance (via Triglyceride-Glucose Index (TyG)), Visceral Adiposity Index (VAI), intact parathormone (iPTH), bone turnover markers and Trabecular Bone Score (TBS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We analysed 455 DISH cases and 455 matched controls. During follow-up, 61 individuals fulfilled FO criteria (18%&lt;60 years; 49% female; 65.6% obese; 72.1% hypertensive). Compared with controls, FO subjects had higher TyG (8.65\u00b10.9 vs 8.39\u00b10.4; p=0.002), FO-females showed higher visceral adiposity (VAI 2.30\u00b12 vs 1.44\u00b10.1; p=0.024), and both sexes presented elevated iPTH at E2. In multivariable models, FO was associated with high TyG (adjusted OR=9.31; 95%\u2009CI: 1.04 to 36; p=0.046), low TBS (adjusted OR=0.002; 95%\u2009CI: 0.001 to 0.61) and higher alkaline phosphatase levels (79 vs 69 (U\/L); p=0.043).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>FO represents an active variant that challenges the view of DISH as a quiescent disease affecting older men. Rather than a single entity, FO emerges as a convergent phenotype driven by diverse metabolic pathways and linked to accelerated skeletal changes, including ossification and early trabecular impairment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006024","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:30:14Z","timestamp":1758519014000},"page":"e006024","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["\u2018Fast Ossifier\u2019 in diffuse idiopathic skeletal hyperostosis: a sex-modulated, heterogeneous phenotype with accelerated ossification and early trabecular decline"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0035-3298","authenticated-orcid":false,"given":"Emilio","family":"Pariente-Rodrigo","sequence":"first","affiliation":[{"name":"Cantabrian Health Service, Healthcare Center Camargo-Interior, University of Cantabria, Santander, Spain"},{"name":"Medicine and Psychiatry, University of Cantabria, Santander, Spain"},{"name":"Immunopathology Research Unit, Instituto de Investigaci\u00f3n Valdecilla (IDIVAL), Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Mart\u00edn-Mill\u00e1n","sequence":"additional","affiliation":[{"name":"Medicine and Psychiatry, University of Cantabria, Santander, Spain"},{"name":"Immunopathology Research Unit, Instituto de Investigaci\u00f3n Valdecilla (IDIVAL), Santander, Spain"},{"name":"Bone Metabolism Unit, Hospital Universitario Marqu\u00e9s de Valdecilla Servicio de Medicina Interna, Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giusi","family":"Sgaramella","sequence":"additional","affiliation":[{"name":"High Resolution Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Pardo-Lled\u00edas","sequence":"additional","affiliation":[{"name":"Medicine and Psychiatry, University of Cantabria, Santander, Spain"},{"name":"Immunopathology Research Unit, Instituto de Investigaci\u00f3n Valdecilla (IDIVAL), Santander, Spain"},{"name":"Bone Metabolism Unit, Hospital Universitario Marqu\u00e9s de Valdecilla Servicio de Medicina Interna, Santander, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Fierro-Andr\u00e9s","sequence":"additional","affiliation":[{"name":"Cantabrian Health Service, Healthcare Center Camargo-Interior, Muriedas, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merelyn","family":"Bonome","sequence":"additional","affiliation":[{"name":"Cantabrian Health Service, Healthcare Center Camargo-Interior, Muriedas, 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