NOF - FSMC Osteoporosis Risk Questionnaire

Are You At Risk for Osteoporosis?

Osteoporosis is a major public health threat for 44 million Americans. Ten million individuals already have osteoporosis and 34 million more have low bone mass, placing them at risk for developing osteoporosis and the fractures it causes. Eighty percent of those affected by osteoporosis are women. Known as “the silent thief,” osteoporosis progresses without symptoms or pain until bones start to break, generally in the hip, spine, or wrist.

Learn more about this bone-thinning disease that causes serious fractures. Complete the questionnaire to determine your risk for developing osteoporosis.

QUESTIONS	YES	NO
1. Do you have a small, thin frame and/or are you Caucasian or Asian?
2. Have you or a member of your immediate family broken a bone as an adult?
3. Are you a post menopausal woman?
4. Have you had surgically-induced menopause?
5. Have you taken high doses of thyroid medication or used glucocorticoids (i.e. prednisone) for more than 3 months?
6. Have you taken, or are you taking, immunosuppressive medications or chemotherapy to treat cancer?
7. Is your diet low in dairy products and other sources of calcium?
8. Are you physically inactive?
9. Do you smoke cigarettes or drink alcohol in excess?

The more times you answered “yes,” the greater your risk for developing osteoporosis. If you answered mostly “yes,” please give this form to your healthcare provider and ask about how we can test your bone density, assess your risk for fractures and osteoporosis, and monitor changes in your bone density over time.

Osteoporosis is a complex disease and not all of its causes are known. However, when certain risk factors are present, your likelihood of developing osteoporosis is increased. Therefore, it is important for you to determine your risk of developing osteoporosis and take action to prevent it now.

Osteoporosis is preventable if bone loss is detected early. If your answers to the questions above suggest that you are at risk for developing osteoporosis, see your healthcare provider. He/She may recommend that you have a bone density test. This test will safely and accurately measure your bone density and reliably predict your risk for future fracture.

* Above information and risk assessment questions adapted from the National Osteoporosis Foundation (NOF) *