First-ever identification of diffuse idiopathic skeletal hyperostosis and calcification of the mammary arteries in a woman with moderate cardiovascular risk: a case report

Introduction. Diffuse idiopathic skeletal hyperostosis (DISH) is excessive bone formation and ligamentous ossification associated with male sex, age, metabolic factors (obesity, diabetes), thoracic aortic calcification, and an increased risk of coronary artery disease. Breast arterial calcification (BAC) is currently considered a marker of cardiovascular risk in women, as numerous studies have demonstrated an association between BAC and coronary artery disease, ischemic stroke, and cardiovascular mortality. The prevalence of both DISH and BAC is approximately 10%, so the combination of these two pathological conditions in this patient is of clinical interest.

Brief description. A 49-year-old woman was diagnosed with suspected DISH during a routine chest X-ray, and moderate BAC was also detected for the first time. Three years later, the patient was invited to participate in a research program. On examination, there are no limitations in mobility in any part of the spine. There was class 2 obesity. Thoracic spine radiography reveals calcification of the anterior longitudinal ligament with features characteristic of DISH. Magnetic resonance imaging of the lumbosacral spine and sacroiliac joint reveals no extension of the ossification process to other spine parts except the thoracic region. Blood tests reveal no signs of inflammation, calcium metabolism disorders, dyslipidemia 2a, and a negative HLA-B27 test, which also supports the diagnosis of DISH. Repeat mammography revealed the BAC progression.

Discussion. When both DISH and BAC are detected, it is important to consider that both these conditions are associated with a significant increase in cardiovascular disease risk. Therefore, it is important to pay attention to the patient's existing risk factors and focus efforts on their correction and the identification of asymptomatic forms of other noncommunicable diseases.

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