Bone Health Questionnaire
Bone Density weakness may be related to many other secondary health concerns. Proper assessment and a treatment plan are important to optimize one’s health.
This subjective questionnaire will give your health care practitioner a quick summary of symptoms or signs that may be related to your degree of overall bone health risk. It is not a substitute for professional medical advice from your health care provider.
1. ____ Do you have low bone density or osteoporosis?
2. ____ Do you have a family history of osteoporosis?
3. ____ Have you lost height?
4. ____ Do you drink carbonated beverages?
5. ____ Have you taken corticosteroids, heparin, anti-seizure medications?
6. ____ Have you had hyperparathyroidism or hyperthyroidism?
7. ____ Do you experience digestive upset?
8. ____ Do you suffer from poor overall health?
9. ____ Do you consume excess caffeine or alcohol?
10. ____ Do you smoke?
11. ____ Do you avoid dairy products or have a diet low in calcium?
12. ____ Do you have a low vitamin D intake and/or limited sun exposure?
13. ____ Do you have a thin or small body frame?
14. ____ Are you a woman with ammenohea or menopausal ( loss of the menstrual period) ?
If you have 2 or more Y answers you may be at risk for Bone Density concerns .
It is recommended to consult with your health care professional team.
