Pini SF, et al. - This study was conducted to evaluate the association between DISH and bone microstructure assessed by the trabecular bone score (TBS). Researchers performed a cross-sectional study, nested in a prospective population-based cohort including a total of 968 men (aged ≥ 50 years). They examined clinical covariates, diffuse idiopathic skeletal hyperostosis (DISH), TBS, serum bone turnover markers and bone mineral density (BMD) were analyzed. At the lumbar spine, bone mineral density was significantly higher in the DISH group. In DISH individuals, serum ALP levels were higher, revealing an inverse relationship with TBS that remained significant after adjusting by age and BMI. In men with DISH irrespective of age, BMI, and BMD, TBS values were significantly lower, implying that the presence of DISH might be related to a worse trabecular microstructure.