Diffuse Idiopathic Skeletal Hyperostosis and the Osteological Paradox

Diffuse idiopathic skeletal hyperostosis (DISH) is of interest to bioarchaeologists due to its strong associations with male sex, increased age, and potential associations with obesity, related metabolic conditions, and high social status. However, these possible associations and DISH’s contested status as a pathologic condition raise issues concerning how DISH must be viewed through the lens of the osteological paradox, particularly relating to selective mortality and heterogeneity of frailty. This article explores these concerns by examining recent clinical and bioarchaeological research on the symptomatology, etiology, and epidemiology of DISH and examines how bioarchaeologists should approach the paleoepidemiological interpretation of DISH