Forestier’s Disease

Forestier’s disease is a disease of the skeleton that is associated with increasing stiffening of the spine. The treatment options today allow for a positive course of the disease; severe forms are extremely rare.

Forestier’s Disease

What is Forestier’s disease?

Forestier’s disease is a systemic, non-inflammatory skeletal disease. It is named after the French internist Jacques Forestier, who described it as “senile stiffening hyperostosis of the spine”. Typical for the disease is an ossification of the entheses, i.e. the points on the bone that connect to a joint capsule, a ligament or a tendon.

The spine is mainly affected, but the lower extremities are also damaged. The cause of Forestier’s disease can be traced back to the genes, whereby the actual outbreak can be favored by various diseases such as gout or diabetes. The therapeutic measures are also complex. See homethodology for High Blood Pressure Overview.

They range from operations to the administration of medication to heat therapy and gymnastics. The possible preventive measures are just as extensive, although an outbreak in the corresponding systems can never be completely prevented.


The possible causes for the development of Forestier’s disease are numerous. A striking number of patients have underlying diseases such as circulatory and fat metabolism disorders, gout or diabetes. General restrictions on mobility, such as those that can occur when you are bedridden, are also a possible trigger. Likewise, lack of exercise, weak muscles and a generally unhealthy lifestyle.

However, it is difficult to clearly assign the possible causes, which is why the treatment of Forestier’s disease focuses on the symptoms. In addition, it is now assumed that genetic factors and interactions between certain drugs and substances can also trigger the disease. Above all, fluoride, vitamin A (retinol) and retinoids, as used in therapy.

Isotretinoin and acitretin in particular can lead to Forestier’s disease in connection with certain metabolic conditions. However, the disease can also occur independently and without any recognizable trigger. Due to the large number of possible causes, the diagnosis is usually based on the symptoms.

Symptoms, Ailments & Signs

Forestier’s disease has some unique symptoms. These primarily include back pain and pain in the lower extremities. The symptoms can radiate into the legs and are accompanied by other symptoms such as tendon insertion pain in the kneecap area. The heels are often affected as well, or there is stiffness in the back and limbs.

As the disease progresses, the spine stiffens, which can lead to other symptoms. Difficulty swallowing is another sign of Forestier’s disease, but it can only be clearly attributed to the disease if it is accompanied by other symptoms. This is mainly pain in the back and legs, which is only mildly pronounced at first, but increases sharply within a very short time. Rapid diagnosis and treatment is therefore essential.

Diagnosis & course of disease

Forestier’s disease is diagnosed by various measures. First, a comprehensive medical history is taken with the patient to determine the exact symptoms and their severity. During this conversation, it is also clarified whether there are previous illnesses and whether there have been similar complaints within the family in the past.

In this way, the doctor can get an initial picture and then make the exact diagnosis. For this purpose, X-rays are taken and evaluated using the so-called Resnick criteria. In this way, it is checked whether the bone material has a coating on the right side, which is a clear indication of Forestier’s disease. Within the differential diagnosis, other diseases are excluded by further examinations.

The course of the disease is positive with early treatment. If the therapeutic measures are initiated quickly, no severe forms are to be expected, with permanent consequential damage not being uncommon. This can lead to stiff limbs, problems with the vertebrae or, in severe cases, to a weakened back. Early treatment prevents these consequential damages in most cases.


In most cases, there are no special complications or serious courses with Forestier’s disease. The disease can be limited relatively well with various therapies, so that the everyday life of those affected is not restricted. Patients primarily suffer from severe back pain as a result of the disease. This pain can also radiate to other regions of the body and cause discomfort there.

Pain at rest can also occur at night, which affects sleep and can lead to sleep disorders or depression. The patient’s quality of life is significantly reduced and limited by Forestier’s disease. Difficulty swallowing can also limit food and fluid intake, leading to malnutrition or dehydration.

The treatment of this disease can be carried out with the help of drugs and through therapies. There are no complications. As a rule, most discomfort and pain can be limited, although patients depend on lifelong treatment. However, life expectancy is not reduced by Forestier’s disease.

When should you go to the doctor?

In the case of the skeletal disease Forestier’s disease, the first pain and stiffness in the lower back usually trigger a visit to the doctor. The predisposition to this disease is often genetic. Forestier’s disease can also be triggered in other ways. Those affected experience symptoms at a relatively young age that doctors usually associate with old age.

The sooner the first visit to the doctor for Forestier’s disease takes place, the better the therapy can take effect. If the predisposition to this disease is already known in the family, certain preventive measures can even be taken. However, this does not mean that an outbreak of Forestier’s disease can be reliably prevented. If the spinal column has already started to stiffen, the doctors treating you can only alleviate and limit the symptoms with heat treatment, exercise therapy, pain-relieving medication or, if necessary, surgery.

People affected by Forestier’s disease can expect many years of treatment and regular follow-up. An early visit to the doctor is also advisable because Forestier’s disease is often accompanied by comorbidities such as diabetes, lipid metabolism disorders or circulatory disorders. In addition, the symptoms that occur – such as back pain radiating into the legs or difficulty swallowing – could also indicate other diseases. In order to rule this out, it is advisable to go to the doctor as early as possible.

Treatment & Therapy

Forestier’s disease cannot be treated causally so far. The therapy therefore focuses on the symptomatic treatment with the help of painkillers – in Forestier’s disease mainly strong analgesics are administered -, anti-inflammatory drugs and other drugs.

In addition, heat applications and massages can be performed to relieve muscle tension and make the muscles and joints more flexible. Physiotherapy also serves this purpose and helps to avoid functional impairments. Depending on the severity of the disease, the measures mentioned can also be used to strengthen limited bodily functions again.

In general, the treatment of Forestier’s disease is a long-term therapy that is never fully completed. Those affected are usually treated until the end of their lives and, despite comprehensive therapy measures, must expect a significant reduction in their quality of life.

Outlook & Forecast

Forestier’s disease has a mixed prognosis. The problem appears that the actual cause cannot be treated. The therapy aims to maintain mobility. Physiotherapy is usually prescribed to prevent stiffening of the spine. Building muscles also seems to promise success. The success of such a therapy is strongly dependent on the self-motivation of the person concerned. Ultimately, however, it cannot be ruled out that the quality of life suffers. In principle, a shortening of lifespan is not to be expected as a result of Forestier’s disease.

The disease occurs in five out of every hundred patients in Europe; studies show it. The group of senior citizens is particularly affected. Basically, the risk of developing Forestier’s disease increases with age. When comparing both sexes, it is striking how often men suffer from the typical symptoms. Other underlying diseases such as diabetes and a lipid metabolism disorder increase the risk of Forestier’s disease.

Without treatment, the symptoms increase. The disease can then cause considerable immobility of the spine, which no longer allows you to carry out everyday activities. They even cause swallowing difficulties.


The prevention of Forestier’s disease is limited to the aforementioned exercises to build muscle. Jacobson ‘s progressive muscle relaxation is just as effective as autogenic training and can help prevent the disease. In addition, a healthy lifestyle with sufficient exercise and a healthy diet should be maintained.

In this way, underlying diseases such as diabetes or gout, which can accelerate the onset of the disease, can be avoided. Particular caution is required when taking certain medications that contain the substances mentioned. Finally, risk groups should be examined regularly and have a comprehensive diagnosis made as soon as the first symptoms appear.


People diagnosed with Forestier’s disease must ensure that their skeletal and muscular systems are adequately warmed up in order to stabilize their organism as a whole. Any exposure to cold should therefore be avoided. Wearing appropriate clothing and warm baths can help relieve discomfort. The entire musculoskeletal system must be trained continuously.

Corresponding exercises can be learned in accompanying physiotherapy and implemented independently. The general well-being of the sick person must be improved and strengthened. Regular training sessions are essential for this. A healthy lifestyle with sufficient sleep and a balanced diet should be a matter of course. In order to maintain general vitality, harmful substances such as alcohol and nicotine must be avoided.

Forestier’s disease cannot be cured until now. The consequence for those affected is long-term therapy until the end of their lives. The mental state of the patient plays an important role in this disease. With a stable psyche, everyday life with Forestier’s disease can be mastered better.

Relaxation techniques, which help to reduce stress and thus build up the inner balance of the patient, ensure mental strengthening. In self-help groups and special internet forums, sufferers can exchange ideas with other sufferers. There they receive targeted assistance and individual tips for dealing with this disease in everyday life.

You can do that yourself

Patients suffering from Forestier’s disease can strengthen and stabilize their organism by ensuring that their skeletal and muscular systems are supplied with sufficient heat. Drafts and the effects of cold should be avoided. Warm baths and wearing appropriate clothing are helpful in relieving existing symptoms.

In addition, the musculoskeletal system should be trained daily despite all the adversities. Special exercises to support the body can be learned in physiotherapy and then implemented independently. Regular training sessions are necessary to improve well-being and reduce existing complaints.

Vitality is to be promoted through a healthy lifestyle and a balanced diet. The consumption of harmful substances such as nicotine or alcohol should be avoided. Since the diagnosis of Forestier’s disease entails long-term therapy until the end of life, mental strength must be strengthened. Dealing with the disease in everyday life is easier if the psyche is stable and healthy. Various relaxation techniques help to reduce existing stressors and build inner balance.

In addition, therapeutic treatments can be used so that the developments and the course of the disease are well processed. In an exchange with other sufferers, communication can be established in self-help groups or special Internet forums. This provides assistance and individual tips for everyday life.