Bone Density Questionnaire (v1) | <ORGANIZATION NAME> |
Yes | No | |
Had menopause (women only)? | ||
Being treated for osteoporosis? | ||
Prior fracture? |
Yes | No | |
Previous fracture? | ||
Parent fractured hip? | ||
Currently smoking? | ||
Glucocorticoids? | ||
Rheumatoid Arthritis? | ||
More than 3 alcoholic drinks/day? |