Are You?
Female
Male

What is Your Age?
Under 34 years old
35-55 years old
56-75 years old
Over 75 years old

Are You?
Caucasian
African American
Hispanic

Do you have a "fair" complexion?
Yes
No

Do you have a small-boned frame?
Yes
No

Are you thin?
Yes
No

Do you eat at least 5 servings of dairy products each day OR take a calcuim supplement?
Yes
No

Do you have a family history of osteoporosis?
Yes
No

Do you have relatives with a history of fractures or broken bones after age 35?
Yes
No

Have you lost more than 2 inches in height since age 25?
Yes
No

Do you REGULARLY take these medications?
(add 1 point for each medication in the categories below -- these classes of medications can cause rapid bone loss and/or decrease in calcium absorption)
Cortisone (steroids)
Antacids
Anticonvulsants
Thyroid
Laxatives
Blood Thinners

Do you smoke?
Yes
No

Do you drink more than 4 cups of coffee, or other beverages with caffeine, each day?
Yes
No