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Vitamin D Deficiency: The Unrecognized Cause of Flank Pain

Dina O Abdulazima, Mona M Salemb, Mohammed Hassanc, Ahmed Abdoc, Esam Rashadc and Usama AA Sharaf El Din

Background: 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 deficiently has been reported as common problem worldwide with special predilection to Middle East area.

Objective: In this study, we looked for vitamin D deficiency in patients with flank pain associated with tenderness over the tips of the lowermost ribs.

Cases and methods: 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 eighty seven of these patients had distinct tenderness over the costal margin (groupB1) that could not be explained by history and radiology. All patients of group B were tested for serum level of 25(OH) vitamin D.

Results: Very low serum level of 25(OH) vitamin D was detected in all cases of group B1 and in only 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.

Conclusion: 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.