A nurse is educating a client with osteoporosis about dietary interventions to improve bone health. Which statement by the client indicates a need for further teaching?

Choice A reason: Tobacco use accelerates bone loss by reducing osteoblast activity and blood flow to bones, increasing osteoporosis risk. Cutting down on smoking improves bone density by enhancing bone formation and reducing resorption, a key preventive measure for women.
Choice B reason: Limiting alcohol to two drinks daily is not specific enough, as even moderate alcohol can impair calcium absorption and osteoblast function, increasing osteoporosis risk. Guidelines recommend minimal alcohol consumption, making this less accurate for prevention.
Choice C reason: Strengthening exercises (e.g., resistance training) stimulate osteoblast activity, increasing bone density and strength. This is critical for preventing osteoporosis, as mechanical stress on bones enhances mineralization, reducing fracture risk in women, especially postmenopausal.
Choice D reason: Calcium and vitamin D are essential for bone health. Calcium forms bone matrix, and vitamin D enhances its absorption. Adequate intake prevents bone resorption, maintaining bone density and reducing osteoporosis risk, making this a cornerstone of prevention.
Choice E reason: Weight-bearing exercises like walking stimulate bone formation by applying mechanical stress, increasing osteoblast activity. Walking 30 minutes three times weekly improves bone density and reduces fracture risk, making it an effective strategy for osteoporosis prevention in women.

Choice A reason: Stress fractures result from repetitive microtrauma, common in athletes, not typically associated with abuse. In children, they occur from overuse (e.g., sports), not acute trauma, making them less suspicious for non-accidental injury compared to other fracture types.
Choice B reason: Compound fractures, where bone pierces the skin, result from high-impact trauma (e.g., falls). While possible in abuse, they are less specific, as they occur in accidents, making them less indicative of non-accidental injury than spiral fractures.
Choice C reason: Spiral fractures occur from twisting forces, often seen in abuse when a limb is forcefully twisted (e.g., by an adult). In children, whose bones are flexible, spiral fractures suggest significant force, raising suspicion of non-accidental trauma.
Choice D reason: Greenstick fractures, where the bone bends and partially breaks, are common in children due to pliable bones. They occur in accidents or minor trauma, making them less specific to abuse compared to spiral fractures’ association with twisting mechanisms.