Low vitamin D and folate levels are associated with costochondritis: a retrospective cross-sectional study on children with impaired bone health

The etiology of pediatric costochondritis, a common cause of musculoskeletal chest pain, remains poorly understood. This study aimed to identify nutritional risk factors for costochondritis by comparing children with this condition to those with post-rickets skeletal deformities. This retrospective, single-center study included 610 children (aged 3–18) stratified into costochondritis-only (Group A), rickets-like deformity-only (Group B), and coexistence (Group C) groups. We analyzed demographic data and serum levels of various nutrients. Multivariable logistic regression was performed to identify independent factors associated with costochondritis (Groups A + C vs. Group B). Age-stratified subgroup analyses (3–8 years and 8–18 years) were also conducted. Both Group A and Group C had significantly lower serum 25-hydroxyvitamin D [25(OH)D] and folate levels than Group B (P < 0.001). Multivariable logistic regression confirmed that lower 25(OH)D (OR = 0.772, P = 0.011) and folate (OR = 0.686, P < 0.001) levels were independently associated with higher odds of costochondritis. Other factors significantly associated with increased odds of costochondritis included older age, female sex, check-ups during autumn and winter, and higher selenium levels. Subgroup analysis revealed that in children aged 3–8 years, low 25(OH)D was the predominant risk factor, while in those aged 8–18 years, lower folate emerged as the key risk factor. Lower serum 25(OH)D and folate were independently associated with increased risk of costochondritis in children, with vitamin D deficiency predominating in ages 3–8 and folate in ages 8–18. These patterns suggest age-related shifts in nutritional risk factors. Screening for vitamin D in younger and folate in older children with costochondral symptoms may help identify treatable deficiencies. Prospective and interventional studies are needed to confirm these associations and assess preventive potential.