J Bone Miner Metab. 2017 Nov 9. doi: 10.1007/s00774-017-0874-z. [Epub ahead of print]
Abdulazim DO1, Salem MM2, Hassan M3, Abdo A3, Rashad E3, Sharaf El Din UAA4.
- 40% of flank/loin pain was not due to urinary abnormality
- 27% of flank/loin pain was in costal margin
Note: The costal margin connects the eighth through tenth ribs to the sternum.
- Every single person with costal margin tenderness/pain had very low level of Vitamin D
“Very low” may be < 10 ng or might be < 20 ng – get the PDF to find out
Pain in this region has been one of the best determinations of low vitamin D for over a decade
- Quick, free, self test of vitamin D deficiency has the following image
1 Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Cairo, Egypt.
2 Endocrinology, International Kidney Center, Cairo, Egypt.
3 Nephrology, International Kidney Center, 58th Abbas El Akkad St, Nasr City, Cairo, 11759, Egypt.
4 Nephrology, International Kidney Center, 58th Abbas El Akkad St, Nasr City, Cairo, 11759, Egypt. usamaaas at gmail.com.
Loin pain is frequently not associated with any urinary abnormality. Musculoskeletal abnormalities are not uncommon as alternative cause of flank pain. Osteomalacia of the ribs was infrequently encountered as the cause of flank pain. Vitamin D deficiency has been reported as a common problem worldwide with special predilection to the Middle East area. In this study, we looked for vitamin D deficiency in patients with flank pain associated with tenderness over the tips of the lowermost ribs. Out of 783 patients presenting with unilateral or bilateral flank pain to a single center over a period of 3 years, 316 did not have a definite urologic cause (group B ). One hundred and eighty-seven of these patients had distinct tenderness over the costal margin (group B1) that could not be explained by history and radiology. All patients of group B were tested for serum levels of 25(OH) vitamin D.
Very low serum levels of 25(OH) vitamin D was detected in all cases of group B1 and in only 26.4% of the remaining cases of group B (group B2).
Relief of flank pain was noticed within 2 months in 55.1% of vitamin D deficient cases. In patients presenting with flank pain, the existence of tenderness of the last ribs instead of the renal angle proper should alert to a possible cause in the rib cage. Estimation of serum vitamin D level should be performed in these cases.