Published February 10, 2026 | Version v1
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Metabolic and Osteogenic Susceptibility in DISH: A Prognostic Index from Propensity Score Modelling (Accepted manuscript)

Authors/Creators

  • 1. ROR icon Universidad de Cantabria
  • 2. ROR icon Instituto de Investigación Marqués de Valdecilla
  • 3. ROR icon Servicio Cántabro de Salud
  • 4. ROR icon Marqués de Valdecilla University Hospital
  • 5. ROR icon Osakidetza
  • 6. EDMO icon University of Cantabria

Description

Accepted Manuscript (Author Accepted Version) of the article:
"Metabolic and osteogenic susceptibility in DISH: A prognostic index from propensity score modelling"

The final Version of Record is published in Bone (Elsevier):

Pariente E, Martín-Millán M, Maamar M, Pardo-Lledías J, Basterrechea H, Petitta B, Bianconi C, Ramos-Barrón C, Martínez-Taboada V, Hernández JL. Metabolic and osteogenic susceptibility in DISH: A prognostic index from propensity score modelling. Bone. 2026 Feb 4:117819. doi: 10.1016/j.bone.2026.117819. Epub ahead of print. PMID: 41651202.

DOI: https://doi.org/10.1016/j.bone.2026.117819

© 2026 Elsevier. This manuscript is shared under the CC BY-NC-ND 4.0 license.

Abstract

 

Objective

Diffuse idiopathic skeletal hyperostosis (DISH) is increasingly recognised as a systemic condition associated with trabecular deterioration, and metabolic or vascular disruption. Within this spectrum, a phenotype characterised by accelerated skeletal progression has been described (Fast Ossifier, FO). We aimed to develop sex-specific prognostic indices derived from propensity score (PS) covariates—FOSSI-F (women) and FOSSI-M (men)—to stratify the risk of FO status within a population-based cohort.

Method

Using longitudinal data from the Camargo Cohort, sex-stratified logistic models were constructed based on PS-derived upstream variables. Internal validation (bootstrap), discriminative performance (ROC/AUC) and exploratory analyses (non-linear models, clustering, Shapley-R2 decomposition) were performed.

Results

We analysed 178 individuals (61 with FO; 64% women; mean age = 61 ± 7 years). FOSSI-F included visceral adiposity and hypertension, FOSSI-M included waist circumference, and both incorporated age, body mass index and cardiometabolic index. They showed high discriminatory capacity (AUC = 0.875 in women and 0.836 in men). Non-linear modelling revealed a broad sigmoid transition zone in women (approximately 5.8–9.6) and a sharp threshold-like pattern in men (0.45–0.71). In high FOSSI values, clustering analyses identified insulin resistance predominating in women and endocrine–inflammatory signals in men. Shapley analysis revealed TyG as the most influential factor in FOSSI-F variance (79.8%), while iPTH was in FOSSI-M (59.5%). Both indices correlated inversely with trabecular bone score (p < 0.0001).

Conclusion

FOSSI-F and FOSSI-M are sex-specific, PS-derived prognostic indices that capture latent metabolic–osteogenic susceptibility associated with FO status. Their strong internal discrimination supports their use for risk stratification and research-oriented interpretation.

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Additional details

Identifiers

DOI
10.1016/j.bone.2026.117819

References

  • Pariente E, Martín-Millán M, Sgaramella G, et al. 'Fast Ossifier' in diffuse idiopathic skeletal hyperostosis: a sex-modulated, heterogeneous phenotype with accelerated ossification and early trabecular decline. RMD Open. 2025;11:e006024. https://doi.org/10.1136/rmdopen-2025-006024