A 39-year-old woman comes to the physician because of a 1-month history of aching at both knees. She has no history of joint pain. She is employed as a pharmacist. She has smoked one pack of cigarettes daily for 20 years. She drinks 2 beers nightly. She is 6’3″ (191 cm) and weighs 95 kg (210 lb). BMI is 26. Physical examination shows no abnormalities. There is no crepitus and range of motion is full. There is no pain with weight bearing. Which of the following is the most appropriate recommendation to decrease the risk of osteoarthritis in this patient?
Alcohol cessation
Avoidance of high-impact physical activities
Calcium and vitamin D supplementation
Increase weight bearing exercise
Smoking cessation
Weight loss
