Fleischer Inuuteq, Schæbel Louise K, Albertsen Nadja, Sørensen Vibeke N, Andersen Stig
Arctic Health Research Centre, Aalborg University Hospital, Aalborg, Denmark.
Sisimiut Health Care Centre, Sisimiut, Greenland.
Rural Remote Health. 2017 Jan-Mar;17(1):3910. doi: 10.22605/rrh3910. Epub 2017 Feb 15.
Osteoporosis is a frequent disease in many populations. The hallmark is fragility fractures, which are harbingers of future fractures, disability, mortality and cost on society. The occurrence increases with age, low vitamin D level and smoking. Smoking rates are high, vitamin D is low and life expectancy is rising steeply in Greenland, as is the need for focus on osteoporosis. We report a case that uses a simple and readily available tool to diagnose osteoporosis at the hospital in Sisimiut, a town of 5000 inhabitants on the west coast of Greenland.
A 51-year-old Inuit woman was seen due to lower back pain. No trauma could be recalled. Laboratory results showed a low vitamin D level and normal S-calcium, S-phosphate, S-parathyroid hormone, S-thyrotropin, erythrocyte sedimentation rate, S-creatinine and hemoglobin. The lateral chest radiograph demonstrated a reduction of anterior height of the seventh and ninth thoracic vertebral bodies of 50% and 40% respectively.
Chest radiographs are frequently done in the towns along the vast coastline of Greenland, the world's largest island. They are transferred to the hospital in the capital city Nuuk using existing tele-technology, and specialist evaluations are given in electronic records available at the coastal hospitals. Effective therapies for osteoporosis are available and the identification of vertebral fractures that merit treatment may prevent future fractures, morbidity and mortality. Fragility fractures are frequent in old age and the steep rise in life expectancy and in the number of old people in Greenland emphasize the need for a focus on management of osteoporosis. Geography provides a diagnostic challenge to rural and remote areas that can be overcome by the use of lateral chest radiographs as it relies on facilities readily available. Clinical risk assessment tools with high specificity may support further osteoporosis risk prediction in remote Arctic societies.
骨质疏松症在许多人群中是一种常见疾病。其标志是脆性骨折，而脆性骨折是未来骨折、残疾、死亡以及社会成本的先兆。随着年龄增长、维生素D水平降低和吸烟，脆性骨折的发生率会增加。在格陵兰岛，吸烟率很高，维生素D水平较低，而且预期寿命正在急剧上升，因此对骨质疏松症的关注需求也在增加。我们报告了一个病例，该病例使用一种简单且易于获得的工具，在格陵兰岛西海岸一个有5000居民的小镇西西缪特的医院诊断骨质疏松症。
一名51岁的因纽特女性因腰痛前来就诊。她回忆不起有过外伤史。实验室检查结果显示维生素D水平较低，而血清钙、血清磷、血清甲状旁腺激素、促甲状腺激素、红细胞沉降率、血清肌酐和血红蛋白水平正常。胸部侧位X线片显示第七和第九胸椎椎体前缘高度分别降低了50%和40%。
在世界最大岛屿格陵兰岛漫长海岸线上的城镇，胸部X线片检查很常见。这些X线片通过现有的远程技术传输到首都努克的医院，沿海医院可在电子记录中获得专家评估结果。骨质疏松症有有效的治疗方法，识别出值得治疗的椎体骨折可以预防未来的骨折、发病和死亡。脆性骨折在老年人中很常见，格陵兰岛预期寿命和老年人数量的急剧上升凸显了关注骨质疏松症管理的必要性。地理因素给农村和偏远地区带来了诊断挑战，但通过使用胸部侧位X线片可以克服这一挑战，因为它依赖于现有的设施。具有高特异性的临床风险评估工具可能有助于在偏远的北极社会进一步预测骨质疏松症风险。
