An epidemiologic study of postmenopausal women is performed. The subjects undergo periodic examination by dualenergy x-ray absorptiometry (DEXA) scan performed on the hip and lumbar vertebrae to evaluate bone mineral density over the next 10 years. They respond to a survey regarding their past and present use of drugs, diet, activity levels, history of bone fractures, and medical conditions. A subset of the subjects is identified whose bone mineral density is closest to that of the young adult reference range and in whom no bone fractures have occurred. The survey data from this subset of women are analyzed. Which of the following strategies is most likely to be supported by the study data to provide the best overall long-term reduction in risk of fracture in postmenopausal women?

A. Supplement the diet with calcium and vitamin D after menopause
B. Begin estrogen replacement therapy after a fracture
C. Avoid corticosteroid therapy for any inflammatory condition
D. Increase bone mass with exercise during childhood and young adulthood
E. Limit alcohol use, and avoid use of tobacco