Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Cairo, Egypt.
Endocrinology, International Kidney Center, Cairo, Egypt.
J Bone Miner Metab. 2018 Sep;36(5):605-608. doi: 10.1007/s00774-017-0874-z. Epub 2017 Nov 9.
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 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.
腰痛通常与任何尿路异常无关。骨骼肌肉异常并不少见，是腰痛的另一个常见原因。肋骨骨软化症作为腰痛的病因并不常见。维生素 D 缺乏症在全球范围内是一个常见问题，在中东地区尤其普遍。在这项研究中，我们在肋软骨压痛的腰痛患者中寻找维生素 D 缺乏症。在 3 年内，有 783 名单侧或双侧腰痛患者到一家中心就诊，其中 316 名患者没有明确的泌尿系统病因（B 组）。这些患者中有 187 名患者的肋缘有明显压痛（B1 组），无法用病史和影像学检查来解释。B 组所有患者均检测血清 25(OH)维生素 D 水平。B1 组所有病例及 B 组其余 26.4%病例（B2 组）均检测到血清 25(OH)维生素 D 极低水平。维生素 D 缺乏症患者中，55.1%在 2 个月内腰痛缓解。在出现腰痛的患者中，最后肋骨的压痛而不是肾脏区域的压痛可能提示肋骨胸廓有潜在病因。这些情况下应检测血清维生素 D 水平。
