{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:13:01Z","timestamp":1792789981479,"version":"4.5.0"},"reference-count":123,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"United States Department of Education","award":["Title III-HBGI-RES"],"award-info":[{"award-number":["Title III-HBGI-RES"]}],"id":[{"id":"https:\/\/ror.org\/021adze67","id-type":"ROR","asserted-by":"crossref"}]},{"award":["Title III-HBGI-RES"],"award-info":[{"award-number":["Title III-HBGI-RES"]}],"id":[{"id":"https:\/\/ror.org\/021adze67","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a systemic, non-inflammatory skeletal disorder characterized by progressive calcification and ossification of spinal ligaments and entheses. Its strong associations with aging, obesity, type 2 diabetes, and metabolic syndrome raise the possibility that metabolic and inflammatory pathways may contribute to disease development. The gut microbiota participates in nutrient metabolism, short-chain fatty acid production, bile-acid transformation, intestinal-barrier maintenance, and immune regulation; these functions provide a plausible framework for examining whether intestinal dysbiosis may influence spinal and musculoskeletal tissues. This narrative review therefore evaluates the potential relationship between gut microbiota, DISH, and related spinal degenerative diseases. It considers the nutritional, metabolic, immunological, and host-interaction functions of the gut microbiota before examining proposed gut\u2013spine, gut\u2013bone, gut\u2013joint, gut\u2013disc, gut\u2013ligament, and gut\u2013muscle pathways. Particular attention is given to the apparent paradox that most microbiome\u2013bone evidence concerns osteoporosis and bone loss, whereas DISH is characterized by excessive ectopic bone formation. Differences in short-chain fatty acid concentration, receptor expression, local versus systemic signaling, and osteoblast\u2013osteoclast microenvironments may produce divergent skeletal effects, but these mechanisms have not been tested directly in DISH. Recent studies support associations between selected microbial taxa and intervertebral disc degeneration or spinal stenosis; however, direct clinical evidence linking gut microbiota to DISH remains limited. Consequently, dietary modification, probiotics, prebiotics, and fecal microbiota transplantation should be regarded as research considerations rather than established treatments for DISH. Well-characterized case\u2013control and longitudinal studies integrating microbiome profiling, metabolomics, inflammatory markers, and serial imaging are required to determine whether reproducible microbial or metabolite signatures precede DISH onset or progression. The pathways discussed in this review are therefore presented as biologically plausible, testable hypotheses and not as established causal relationships.<\/jats:p>","DOI":"10.3390\/nu18193168","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:35:59Z","timestamp":1790595359000},"page":"3168","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diffuse Idiopathic Skeletal Hyperostosis (DISH): Potential Links Between Gut Microbiota and Spinal Degenerative Diseases"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9058-1616","authenticated-orcid":false,"given":"Iddrisu","family":"Ibrahim","sequence":"first","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"The Industrial Hemp Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"African Drug Discovery and Innovation Network, Sunyani P.O. Box AB45, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelci","family":"Lawrence","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"The Industrial Hemp Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2001-985X","authenticated-orcid":false,"given":"Othreniel Angel","family":"Forte","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Latrell","family":"Huitt","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navitri Chandra","family":"Naidu","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Ajibola","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"The Industrial Hemp Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhuan","family":"Xu","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"The Industrial Hemp Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robertson K.","family":"Boakai","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"African Drug Discovery and Innovation Network, Sunyani P.O. Box AB45, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3118-7619","authenticated-orcid":false,"given":"Fortune","family":"Akabanda","sequence":"additional","affiliation":[{"name":"Department of Food Science and Technology, University for Development Studies, Tamale P.O. Box TL1350, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2703-3393","authenticated-orcid":false,"given":"James","family":"Owusu-Kwarteng","sequence":"additional","affiliation":[{"name":"African Drug Discovery and Innovation Network, Sunyani P.O. Box AB45, Ghana"},{"name":"Department of Food Science and Technology, School of Agriculture and Technology, University of Energy and Natural Resources, Sunyani P.O. Box 214, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3556-803X","authenticated-orcid":false,"given":"Olufemi S.","family":"Ajayi","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"The Industrial Hemp Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4561-8245","authenticated-orcid":false,"given":"Joseph Atia","family":"Ayariga","sequence":"additional","affiliation":[{"name":"The Microbiology Program, College of Science, Technology, Engineering, and Mathematics (C-STEM), Alabama State University, Montgomery, AL 36104, USA"},{"name":"African Drug Discovery and Innovation Network, Sunyani P.O. Box AB45, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"ref_1","first-page":"593","article-title":"Diffuse idiopathic skeletal hyperostosis of the spine","volume":"8","author":"Szulc","year":"2018","journal-title":"J. Educ. Health Sport"},{"key":"ref_2","first-page":"100239","article-title":"Hyperostosis cranialis interna and an ectopic ossification on the endosteal dura deep to the trigeminal ganglion: Case analysis and clinical implications","volume":"30","author":"Srinivasan","year":"2023","journal-title":"Transl. Res. Anat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1002\/ca.22716","article-title":"Diffuse idiopathic skeletal hyperostosis: Diagnostic, clinical, and paleopathological considerations","volume":"29","author":"Holgate","year":"2016","journal-title":"Clin. 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