Costochondritis and Vitamin D deficiency

Some people have reported improvement in their costochondritis symptoms after increasing their Vitamin D levels. Some of these people were diagnosed with Vitamin D deficiency, and there are numerous case reports available. Vitamin D plays a role in so many processes throughout the body, that proper Vitamin D levels are clearly a critical cornerstone in preventing and treating costochondritis. In this article, we’ll discuss the role of Vitamin D in the body, the effects of deficiency, and the link between Vitamin D and Costochondritis.

Vitamin D is a fat-soluble vitamin that is vital for the human body. It is crucial for bone health, immune function, neuromuscular function, and plays a role as an anti-inflammatory. Vitamin D is naturally synthesized in human skin by exposure to sunlight. This synthesized vitamin D is inactive and is converted into an active form by two hydroxylation processes. One of these occurs in the liver converting it to 25-hydroxyvitamin D (or calcifediol). The second hydroxylation occurs in kidneys forming an active 1,25 dihydroxy vitamin D (calcitriol). Despite its natural synthesis, Vitamin D deficiency is one of the most common deficiencies in people of all ages throughout the world. It is more prevalent in people who live in areas with less sunlight exposure.

Benefits of Vitamin D

Vitamin D is crucial for skeletal health by regulating the amount of phosphate and calcium in the body. These are important for healthy bone formation and mineralization. It is also vital in supporting the immune system; studies have shown it to reduce exacerbation of chronic respiratory conditions such as COPD. Vitamin D also plays a vital role in various metabolic processes of the body, including the regulation of insulin. It also supports the cardiovascular system. Studies also demonstrated the role of vitamin D in the regulation of cellular growth, which plays a part in reducing cancer progression. If you haven’t figured it out yet, vitamin D is kind of important!

Signs and Symptoms of Vitamin D Deficiency

The deficiency of vitamin D is not uncommon as not everyone is not exposed to sunlight and some people experience decreased intake of Vitamin D less than RDI (400-800IU). The presentation of deficiency varies among individuals, and some may experience no symptoms at all. The signs and symptoms are nonspecific, and it is difficult to diagnose it only based on symptoms.

Vitamin D deficiency can present with these signs and symptoms:

  • Frequent infections
  • Tiredness or fatigue
  • Pain in back and bones
  • Mood changes
  • Hair loss
  • Impaired wound healing
  • Muscle aches
  • Obesity
  • Diabetes
  • Hypertension
  • Chronic fatigue syndrome
  • Osteoporosis
  • Neurodegenerative disorders
  • Depression

Risk Factors for Vitamin D Deficiency

These risk factors can make an individual prone to Vitamin D deficiency:

  • Having dark skin (melanin absorbs UV rays and reduces the production of Vitamin D in the skin)
  • Elderly (with age the compound 7-dehydrocholesterol which is needed to synthesize Vitamin D decreases)
  • Obesity (can cause lower vitamin D levels)
  • Decreased intake of foods containing Vitamin D
  • Using sunscreens while going out or staying indoors
  • Living in an area with little sunlight

Vitamin D Deficiency and Costochondritis

The deficiency of vitamin D usually presents with generalized bone and muscular pains. The relation between vitamin D deficiency and costochondritis has been studied, but only a few cases were reported with this scenario. Costochondritis is an inflammatory condition that presents with chest pain that is more noticeable while breathing. There is an inflammation of the costal cartilages and sternal joints on the chest wall near the sternum. Chest pain presentation is first assessed for any cardiopulmonary abnormality and afterward assessed for muscular abnormalities, including costochondritis.

Case Reports for Chest Pain and Vitamin D Deficiency

There were two reported cases of chest pain in the aformentioned study, both of which are diagnosed with costochondritis and vitamin D deficiency. Both the patients had a history of chronic chest pain with tenderness along the costochondral junctions. Also, both patients said that they did not routinely drink milk and had little sun exposure. Cardiopulmonary examination and investigations were unremarkable. Both cases resulted in the diagnosis of costochondritis. Vitamin D levels were checked and found to be deficient in both patients. Oral vitamin D was started to both patients, and in follow up, the levels returned to normal with the resolution of chest pain. Serum vitamin D is predictive for body stores of vitamin D, however there is controversy about the levels of defining the optimum and deficient.

A report by the National Institutes for Health (NIH) found that serum levels above 20ng/ml (50nmol/l) is sufficient for normal skeletal health. Levels below 20ng/ml (50nmol/l) are considered deficient and below 10ng/ml (25nmol/l) is considered to be a severe deficiency. The patients in the aforementioned study did not have vitamin D levels low enough (< 25 nmol/L (10 ng/mL)) to indicate a diagnosis of osteomalacia, therefore it is suggested that mild vitamin D deficiencies can be the cause of pain along the sternum and costochondral junctions. In such cases, costochondritis may represent an earlier form of osteomalacia.

Though studies have not revealed many reported cases of costochondritis and vitamin D deficiency, several case reports of chest pain and vitamin D deficiency have shown that when treated with Vitamin D supplementation, the patient’s chest pain was resolved. These cases support vitamin D deficiency as a potential causative factor for costochondritis. Thus, in patients with chest pain without any identified cardiopulmonary cause, the doctors should evaluate the patient for vitamin D deficiency. Further, patients presenting with costochondritis who are at risk of developing vitamin D deficiency should have their serum levels checked for Vitamin D.

Effects of Vitamin D Deficiency

Severe vitamin D deficiency can cause rickets in children, which causes bow legs or knock knees (diagnostic of rickets). The children will have soft and weak bones, stunted growth, and skeletal deformities. It is common in children between the ages of 6 months to 36 months. In adults, vitamin D deficiency causes osteomalacia, which can result in diffuse bone and muscle pains and fragile bones prone to fractures. Severe vitamin D deficiency is the most common cause of rickets in children and osteomalacia in adults. Another condition called rachitic rosaries can develop in children due to a vitamin D deficiency, in which costochondral junctions are hypertrophied as a result of defective mineralization. This condition creates the appearance of large beads under the skin.

How To Get Enough Vitamin D

Food alone is not enough to maintain adequate levels of Vitamin D in the body, so sunlight exposure and supplements are a must. Exposing your skin to sunlight for just 15 minutes a day can create enough vitamin D within your body. Skin produces more vitamin D if exposed in the middle of the day. Another way to get enough vitamin D is to take supplements, but take care not to exceed the RDI, which for infants is 400IU/day, for children 600IU/day, and adults between 600-800IU/day. The supplementation dosage in the case of deficiency should be adjusted according to the severity of deficiency.

Hypervitaminosis

Although vitamin D deficiency is common, with supplementation its levels can rise, and if not monitored, can lead to vitamin D intoxication. It can happen when supplements are taken for longer periods. Blood levels of Vitamin D above 150ng/ml (375nmol/l) are considered to be toxic, and the condition can last for months. It can cause increased levels in the blood referred to as hypervitaminosis, elevated levels of calcium (hypercalcemia), kidney damage, poor appetite, nausea, vomiting, constipation or diarrhea, and many other symptoms due to high levels of nutrients in the body. Therefore it is necessary to monitor vitamin D levels regularly while taking supplements.

Vitamin D is certainly an essential vitamin for maintaining optimum skeletal health. Its deficiency is linked to weak bones and generalized aches and pains. The deficiency at earlier stages may manifest as costochondritis. It is imperative that if an individual with chest pain is prone to be vitamin D deficient, he or she must be assessed for vitamin D deficiency after ruling out other causes of chest pain, and treated accordingly.

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