European Spine Journal

, Volume 19, Supplement 2, pp 103–107 | Cite as

Diffuse idiopathic skeletal hyperostosis in the Medici, Grand Dukes of Florence (XVI century)

  • Valentina GiuffraEmail author
  • Sara Giusiani
  • Antonio Fornaciari
  • Natale Villari
  • Angelica Vitiello
  • Gino Fornaciari
Case Report


Diffuse idiopathic skeletal hyperostosis (DISH) is a common systemic disorder characterised by the ossification of the anterior longitudinal spinal ligament involving at least three contiguous vertebrae and by diffuse extraspinal enthesopathies. The condition is associated with the male sex and with advanced age; its aetiology is uncertain, but seems to be related to obesity and diabetes. The most recent studies in archaeological series demonstrated a relation between high social status and the incidence of DISH. The present study examines two cases of DISH found amongst the members of the Medici family buried in the Basilica of San Lorenzo in Florence. The skeletons of the Grand Dukes Cosimo I (1519–1574) and his son Ferdinand I (1549–1609) showed the typical features of the condition. This result is related to the obesity of the Grand Dukes, attested by the written and artistic sources, and to the protein-based alimentation demonstrated by a paleonutritional study, thus furnishing further evidence to the significance of DISH as a life style.


DISH Morbus Forrestier Spinal ankylosis Obesity Diabetes Life style Renaissance 



This study is integral part of the “Medici Project”, performed with the permission of the Superintendence for Florentine Museums.

Conflict of interest statement

None of the authors has any potential conflict of interest.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Valentina Giuffra
    • 1
    Email author
  • Sara Giusiani
    • 1
  • Antonio Fornaciari
    • 2
  • Natale Villari
    • 3
  • Angelica Vitiello
    • 1
  • Gino Fornaciari
    • 1
  1. 1.Division of Palaeopathology, History of Medicine and Bioethics, Department of Oncology, Transplants and Advanced Technologies in MedicineUniversity of PisaPisaItaly
  2. 2.Section of Medieval Archaeology, Department of Archaeology and History of ArtsUniversity of SienaSienaItaly
  3. 3.Section of Clinical Radiology, Department of Clinical PhysiopathologyUniversity of FlorenceFlorenceItaly

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