The discovery opens a new line of research into the biology of accelerated ossification
A study conducted by a multidisciplinary team composed of researchers from the Immunopathology Group at the Valdecilla Health Research Institute (IDIVAL), led by Drs. Emilio Pariente and José Luis Hernández, together with professionals from the Internal Medicine and Rheumatology Departments of the Marqués de Valdecilla University Hospital (HUMV), faculty from the University of Cantabria (UC), and primary care physicians from Camargo, has identified a new rapidly progressing phenotype in diffuse idiopathic skeletal hyperostosis (DISH)—a rheumatologic disease characterized by the progressive ossification of ligaments and entheses.
The finding, published in the scientific journal RMD Open, redefines the traditional view of this disease and establishes a new research field focused on the biology of accelerated ossification, linking bone metabolism, immunity, and metabolic regulation.
“Fast Ossifiers”: a new phenotype in DISH
Traditionally, DISH has been considered a slow-progressing, non-inflammatory, and mildly symptomatic disease that mainly affects older men. However, this study describes for the first time the so-called “Fast Ossifiers” (FO)—patients who develop accelerated ossification of the anterior vertebral ligament along with early deterioration of trabecular bone microarchitecture.
The study was carried out within the framework of the Camargo Cohort through clinical, analytical, and radiographic assessments conducted over a 10-year period. Using the Schlapbach scale, individuals were classified as FO if they progressed by at least two radiographic grades during a single follow-up period—an evolution much faster than expected. In total, 61 FO patients were identified, nearly half of them women and 18% under 60 years old, suggesting that this phenotype also affects younger and more diverse population groups.
Results: metabolic and bone differences by sex
The results reveal that FO patients present a distinct clinical–metabolic profile:
• In women, there is a predominance of increased insulin resistance, greater visceral adiposity, and alterations in bone remodeling markers.
• In men, an inflammatory–endocrine pattern is observed, characterized by a decreased albumin/globulin ratio and elevated parathyroid hormone (iPTH) levels.
In both cases, researchers detected an early reduction in the trabecular bone score (TBS)—an indicator of bone microarchitectural quality—even before any detectable changes in bone mineral density.
The authors propose that the FO phenotype represents a biological state reached through different metabolic and inflammatory pathways, rather than a fixed set of clinical characteristics.
Clinical implications
These findings could shift the current paradigm of DISH. Contrary to the notion of a slow, age-related process, a subgroup of patients is emerging with a rapid, heterogeneous, and metabolically active progression.
The study highlights the need to develop early detection strategies and personalized follow-up approaches that integrate metabolic and bone biomarkers with advanced imaging techniques. Furthermore, this accelerated phenotype could be linked to an increased vascular and metabolic risk, particularly in younger patients—an aspect the researchers plan to explore in future studies.
Collaboration and future directions
The success of this study has been made possible thanks to the synergy between basic research, clinical practice, and primary care—an exemplary collaborative model that reinforces Cantabria’s scientific leadership in biomedical research.
With this discovery, and within its research line on DISH, the Immunopathology Group at IDIVAL consolidates a new area of investigation into the biology of accelerated ossification, pioneering the connection between bone metabolism, immunity, and metabolic regulation.
