J Compr Ped. 2021 August; 12(3):e102388. Published online 2021 August 15. doi: 10.5812/compreped.102388. Research Article Assessment of Correlation Between Costochondritis and Vitamin D Insufficiency in School-age Children Yazdan Ghandi 1, * , Danial Habibi 2 and Ozra Mohajer 3 1 Associate Professor of Pediatrics Cardiology, Arak University of Medical Sciences, Arark, Iran 2 Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran 3 School of Medicine, Arak University of Medical Sciences, Arak, Iran * Corresponding author: Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran. Email: drghandi1351@gmail.com Received 2020 March 04; Revised 2021 July 03; Accepted 2021 July 19. Abstract Background: In children, vitamin D deficiency can result in the hypertrophy of costochondral junctions and sternal pain. Objectives: In this study, we aimed at determining the correlation between children’s vitamin D status and costochondritis. Methods: This cross-sectional study included a control group (100 healthy children) and a study group (100 children with cos- tochondritis). Examination of patients included chest radiography, physical examination, history-taking, electrocardiography, echocardiography, and serum measurement of 25-hydroxyvitamin D, phosphorus, calcium, and alkaline phosphatase. The chi- square test, Spearman’s correlation test, and independent samples t-test were also performed for analyzing the data. Results: The groups showed no significant difference regarding age, gender, or body mass index (P = 0.315, P = 0.671, and P = 0.097, respectively). The history of patients experiencing idiopathic chest pain showed cardiac disease in 13% of their families, without report of death in the family. The pain was mainly located in the left precordium (64%), followed by the right precordium and the midsternal region (32% and 18%, respectively). A significantly lower level of 25-OHD was found in the study group than in the control group (P < 0.0001). Based on the findings, the groups were not significantly different regarding the evaluated biochemical param- eters, except for alkaline phosphatase (P = 0.007). The results showed that pain duration and episodes were significantly associated with vitamin D insufficiency (r = -0.621, P = 0.002; r = -0.213, P = 0.021, respectively). Conclusions: Vitamin D insufficiency should be considered in costochondritis. Also, pain duration and episodes have associa- tions with vitamin D insufficiency. This finding emphasizes the necessity of evaluating nutritional parameters in children with non-cardiac chest pain. Keywords: Chest Pain, Child, Costochondritis, Vitamin D 1. Background In children, after serious cardiopulmonary conditions are considered, musculoskeletal disorders, such as costo- chondritis, are the significant causes of chest pain com- monly attributed to the final diagnosis (1). Although the epidemiology of costochondritis is not well established, it is one of the common causes of chest pain in children (2). Costochondritis is described as the inflammatory status of chondrosternal joints in the anterior chest wall or costo- chondral junctions of ribs. The cause is usually unknown and not clearly understood, but it may be related to inflam- mation of junctions where the upper ribs join with the car- tilage to the sternum (3). Vitamin D is necessary for bone health, and severe deficiency can cause rickets in children. Although osteomalacia can cause severe generalized bone pain, there are only reports of vitamin D deficiency associ- ated with chest pain (4). Mohajer et al. (5) showed an association between vita- min D deficiency and chest pain in children, and suggested that the evaluation of vitamin D is needed in children with musculoskeletal chest pain. Another study showed that low vitamin D levels are associated with chronic chest pain in children. The study also provided the necessity of evalu- ating nutritional parameters in children with non-cardiac chest pain (6). Torun et al. found that in pediatric patients, there is a significant association between vitamin D defi- ciency/insufficiency and the duration and frequency of idiopathic chest pain in pediatric patients (7). In this regard, Oh and Johnson (8) suggested an association be- tween chest pain related to costochondritis and vitamin D deficiency. Previous studies emphasized the importance Copyright © 2021, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.