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Bone health coordinator: osteoporosis is preventable with screening, exercise and vitamin D
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Summary
Joan Dobak, a bone health coordinator and PA, told the Paid Leave Podcast that fragility fractures should prompt evaluation, that DEXA scanning and lifestyle measures (exercise, calcium, vitamin D) are central to prevention, and that modern medicines can rebuild bone in high‑risk patients.
Joan Dobak, a certified physician assistant and bone health coordinator at the Connecticut Orthopedic Institute, said early identification and prevention can substantially reduce fractures among older adults. "When you've had one fracture from a slip and fall from a standing height ... that in the orthopedic mind is saying, we really need to put eyes on the bone health," Dobak said.
Dobak told host Nancy Barrow that clinicians use two primary approaches to identify osteoporosis: a clinical diagnosis made after certain fragility fractures (for example, hip or vertebral compression fractures) and measurement with a DEXA scan, the latter described as the "gold standard" for bone density. She said guidelines commonly call for DEXA screening about every two years for older adults, with routine timing often beginning around age 60 for many women and around age 70 for men, but that risk factors may justify earlier testing.
The medical specialist outlined prevention strategies patients can pursue before or after a diagnosis. Exercise that is weight-bearing, resistance-based and focused on balance is central: Dobak recommended walking with added arm resistance, strength work and balance training (single-leg stands progressing toward 30 seconds). On routine activity she said, "Somewhere about 7,000 or 8,000 [steps] is what's optimal," calling that level achievable with daily habits.
Dietary measures include ensuring adequate calcium and vitamin D. The transcript mentions numeric targets—"1,200" and "1,000"—without specifying units; dietary calcium guidelines are typically expressed in milligrams. Dobak emphasized getting calcium from food (dairy and leafy greens) and verifying vitamin D levels by blood test before supplementing. She cautioned that hormone replacement therapy can support bone density but is not a universal frontline treatment because of attendant risks and should be discussed with a gynecologist.
Dobak described available medicines in two classes: antiresorptives (such as oral weekly bisphosphonates or annual IV formulations) used to slow bone loss and anabolic agents (injectable therapies or infusions) used to build bone in patients at high risk of further fractures. "One of the best things about osteoporosis is it's reversible and it's preventable," she said, noting that exercise, adequate dietary calcium and vitamin D together can improve bone density.
Dobak also highlighted modifiable lifestyle risks: nicotine products "poison" bone health and should be eliminated, and alcohol intake of three or more drinks daily is harmful for bones. She stressed fall prevention—many fractures follow simple slips at home—and urged vision, hearing and home-safety checks to reduce risk.
The episode emphasized that bone care often involves caregivers after an injury; identifying fractures promptly and connecting patients to prevention and treatment options can reduce long-term disability and caregiver burden. The podcast concluded with a reminder that people with fracture risk or recent fragility fractures should discuss DEXA screening and treatment options with their providers.
