A 53-year-old woman of Asian descent was recently diagnosed with osteoporosis. Which of the following is NOT considered a risk factor for fracture in patients with osteoporosis?

Choice A reason: High BMI is generally protective against fractures because increased body mass provides mechanical loading that strengthens bones. Choice B reason: Female sex is a recognized risk factor due to lower peak bone mass and postmenopausal estrogen deficiency. Choice C reason: Smoking accelerates bone loss and increases fracture risk by impairing bone formation and calcium absorption. Choice D reason: Excessive alcohol intake is detrimental to bone health and increases fracture risk through multiple mechanisms including falls and bone metabolism impairment.