Osteoporosis: Q&A with Dr Todorovic |20 October 2020

Photo source: Hopkins Medicine

‘Treatment of osteoporosis is difficult if it is delayed’

World Osteoporosis Day is observed every year on October 20, with the aim of raising awareness about the prevention, diagnosis and treatment of this particular condition.

Osteoporosis is said to be a silent, underlying condition which has serious, life-changing impacts on people’s lives, including pain, disability and loss of independence. Worldwide, fractures relating to osteoporosis affect 1 in 3 women and 1 in 5 men over the age of 50 (World Osteoporosis Day).

In the following interview with Dr Miodrag Todorovic, founder of Panafricare Clinic, we learn more about osteoporosis, and how we can prevent and manage this condition.

Seychelles NATION: What is osteoporosis and what are the signs and symptoms?

Dr Todorovic: Osteoporosis is not a disease but a silent condition which is basically manifested with inappropriate amounts of calcium in the bones which makes the skeleton fragile and easy to crack (fracture).

There are not many signs and symptoms of this condition despite many complaining of aches and joint pains. The most common and the first objective manifestation is a sudden easy bone fracture. It is often spontaneous such as when the vertebral body of the spine simply collapses under pressure or during unusual movements. The fracture could also happen to any other bone in the body after a minor trauma due to a loss of the firm and resistant structure.

When somebody gets a broken bone, osteoporosis is already advanced; this is why the bones have to be actively screened before a fracture happens, and if necessary, preventive or corrective treatment is taken.

Seychelles NATION: Who does it mainly affect? What are the risk factors?

Dr Todorovic: Osteoporosis is mostly a female condition related to menopause. Once the hormonal activity of the ovaries stop, the incorporation of calcium into the bones is reduced. This is why this effect is very common in ladies with premature menopause, regardless if it is natural or post-surgery ovariectomy.

Men are less exposed to osteoporosis as the male sexual hormone, testosterone, is produced continuously and enables the continuous uptake of calcium by the bones.

However, both genders are equally sensitive to develop osteoporosis as a secondary condition to other main diseases. This includes autoimmune conditions on corticosteroids, anti-hormonal treatment of some cancers, for example breast and prostate cancer, but also in chronic immunological conditions when patients are treated with prednisolone.

Some bowel inflammatory diseases particularly affecting reabsorption in the small bowel, as well as alcoholism, reduces absorption of vitamin D. Without vitamin D, calcium cannot get into the bones. It is also important to get adequate exposure to sunlight to ensure our bodies make enough vitamin D. Two external components are important for osteoporosis prevention, that is, calcium and vitamin D.

Seychelles NATION: What is the prevalence of osteoporosis in Seychelles?

Dr Todorovic: The human skin produces vitamin D once exposed to the sun and the Seychelles is sunny enough that people should not be affected on this side. Therefore, the very first thought is that there should not be osteoporosis in Seychelles.

However, we can see spontaneous vertebral body fractures, different bones that easily crack and people with repetitive multiple fractures, particularly in the risky groups that I mentioned before.

Seychelles NATION: How is osteoporosis diagnosed?

Dr Todorovic: Osteoporosis is usually diagnosed after the first fracture, but it can be diagnosed far before a fracture in systematic screening of risky groups – firstly ladies, particularly those in early menopause and then every other menopausal woman, followed by the other risk groups.

Why is the systematic screening important? Because if discovered early, there are a few levels of intervention with supplements and medicines to control the condition.

Seychelles NATION: You mentioned that you have a machine at your clinic which measures osteoporosis level. Tell us more about this.

Dr Todorovic: Prevention of osteoporosis is important from many aspects and this is why now all screening programmes for ladies or risk groups contain the bone densitometry test.

Bone densitometry is a technique which measures how solid the bones are and must be done with some blood test, for example FSH, vitamin D blood test, to detect the cause of osteoporosis.

There are two different ways to perform the bone densitometry test; one with an X-ray, the other with an ultrasound.

Even though the X-ray body scan can give a more detailed picture, we prefer the ultrasound technique as it is fast, reliable, and there is no radiation exposure to the patient. This is why at PANAFRICARE CLINIC, we practice bone densitometry in general and include the test in some specific screening packages.

Seychelles NATION: What is your advice for preventing osteoporosis?

Dr Todorovic: I personally think that everyone after the age of 50 should have a scan done and repeat this at least once every 5 years. The risk groups should have their scan done at an even earlier age.

In case of a detected vitamin D deficiency, identify the reason for it and increase exposure to sun or supplement calcium and vitamin D with existing products.

Seychelles NATION: What is your advice for managing osteoporosis if you have already been diagnosed with it? How is it treated?

Dr Todorovic: Treatment of osteoporosis is difficult if it is delayed. However, aside from supplements, patients need medicines which makes calcium consolidate the bones. This is a group of medicines known as bi-phosphanates; they are efficient drugs but also expensive. They need to be taken for long periods of time, with supplements as well.

For anyone who wants to know if they are at risk of developing osteoporosis or are interested to know how strong their bones are, they can contact the clinic and book a bone densitometry test. We will discuss the result and provide a printed report for future reference.

For more information, visit Panafricare Clinic, Le Chantier Mall, Victoria or contact the Clinic:

-           Telephone: 4 321 310

-           Email: info@panafricare.com

-           Follow ‘Panafricare Clinic by Dr. Todorovic’ on Facebook

F. P.