Osteoporosis

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Before Your Doctor Visit

Answer these questions BEFORE your doctor visit. Once completed, print this page and give it to your doctor at your next visit.

Have you had a bone density study? If so, when and what were the results?

Have you ever been treated for osteoporosis? If so with what medication or other treatment plan?

DATE (month/day/year)
/ /
Check or fill in all items that apply.
Do you exercise regularly? YES NO
If so, how many days per week?
Do you drink alcohol? YES NO
If so, how many drinks per day?
Do you drink coffee? YES NO
If so, how many cups per day?
Do you smoke? YES NO
Do you have a family history of osteoporosis? YES NO
Are you postmenopausal? YES NO
If so, are you on hormone replacement therapy? YES NO
Have you broken a bone from a fall in the last three years? YES NO
Are you now or have you in the past taken steroids or anti-seizure medicines? YES NO
How many servings of dairy foods do you eat daily? servings
Are you taking daily supplemental calcium or vitamin D? YES NO
Have you fallen recently due to unsteadiness? YES NO
Have you had a major loss of height since young adulthood? YES NO
Do you feel pain at your spine when bending? YES NO
Take ALL your medications with you whenever you visit your doctor!

This article was reviewed and updated June 2007.

 

Mon, Jan 5, 2009



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