| Family history of osteoporosis or hip/bone fracture |
___ YES ___ NO |
| Had a hysterectomy with ovaries removed (females) |
___ YES ___ NO |
| A post menopausal female |
___ YES ___ NO |
| Family history of osteoporosis or hip/bone fracture |
___ YES ___ NO |
| Had a hysterectomy with ovaries removed (females) |
___ YES ___ NO |
| A post menopausal female |
___ YES ___ NO |
| Broken bone after age forty without associated trauma |
___ YES ___ NO |
| Parent with a hip fracture |
___ YES ___ NO |
| Lost more than one inch in height |
___ YES ___ NO |
| Do you smoke or were you a smoker |
___ YES ___ NO |
| Do you drink daily or consume large amounts of alcohol |
___ YES ___ NO |
| Get little or no exercise |
___ YES ___ NO |
| Consume two or more cups of caffeinated beverages per day |
___ YES ___ NO |
| Do you eat a low fat diet |
___ YES ___ NO |
| Suffer from a condition that prevents proper absorption of foods |
___ YES ___ NO |
| Suffer from a condition that prevents proper absorption of foods |
___ YES ___ NO |
| Ever have an eating disorder like bulimia or anorexia |
___ YES ___ NO |
| Are you a diabetic |
___ YES ___ NO |
| Did you ever have a thyroid problem |
___ YES ___ NO |
| Are you petite or small boned |
___ YES ___ NO |
| Rarely ever out doors or get very little sun light |
___ YES ___ NO |
| Very fair complexion and easily sun burned |
___ YES ___ NO |
| Ever taken prolonged course of corticosteroids |
___ YES ___ NO |
| Ever receive chemotherapy |
___ YES ___ NO |
| Have a stooped posture |
___ YES ___ NO |
| Prolonged loss of your cycle other than pregnancy (females) |
___ YES ___ NO |
| Had gastric bypass therapy |
___ YES ___ NO |
| History of Celiac Disease |
___ YES ___ NO |
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