Bone Density Questionnaire

Measure your risk of Osteoporosis

Please review this list of risk factors and medications that may indicate the need for a bone density test. If you answered ‘yes' to any of them, you are a candidate for a bone density test. Talk to your doctor to schedule your bone density. For Spanish, click here.

Risk Factors:

Family History of Osteoporosis
Rheumatoid Arthritis
Cancer Type
Non Traumatic Fractures
Post Menopausal
Complete Hysterectomy
Malabsorption Problems
Kidney Stones
Colostomy
Dialysis
Smoker
Hyperthyroidism
Depression
Low calcium in diet
Hyperparathyroidism
Bariatric Surgery
Hypothyroidism
Asthma
Depoprovera use
Inactivity
Steroid use
Loss of height of 1 inch or more

Medications:

Methyltrexate
Steroids
Synthroid
Diuretics
Dilantin
Insulin
Depo-Provera

En Espanol:

Por favor tome este questionario. Si su respuesta es ‘si’ para cualquiera de estos riesgos o medicamientos, Usted es un candidato para la pueba de Osteoporosis, Bone density, densidad osea.

Riesgos:

Osteoporosis en su Familia
Arthritis Rheumatoide
Cancer
Historia de Fracturas
Menopausia
Hysterectomia completa
Malabsorpcion
Piedras en Rinones
Extripacion de varios
Colostomia
Dialysis
Fuma
Hyperthyroidismo
Deprecion
Calico en su dieta
Hyperparathyroidismo
Cirujia Bariatrica
Hypothyroidismo
Perdida de 1 o mas pulgadas de altura
Asthma

Toma usted uno de estos Medicamientos?

Methyltrexate
Synthroid
Diureticos
Antiacidos
Dilantin
Insulina
Depoprovera
Esteroides

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