Which of the following is a risk factor for osteoporotic fracture?

• A. Age >60
• B. Prior fracture
• C. Smoking
• D. All of the above

Answer: (D)

Osteoporotic fracture risk grows with factors that reflect weaker bones and higher fragility. Being older than sixty contributes because bone density and quality decline with age, and fall risk generally increases, making fractures more likely. A prior fracture is a strong indicator of underlying bone fragility—once bones have fractured, the likelihood of future fractures rises due to accumulated bone loss and ongoing risk factors. Smoking harms bone health by reducing calcium absorption, impairing bone formation, and potentially lowering estrogen levels, which together weaken bone structure.

Since each of these elements independently increases fracture risk, the option that includes all of them is the most accurate choice.