Name* First Last Email* 19 easy questions to help you understand the status of your Bone Health A. Your non-modifiable risk factors - what you cannot change These are risk factors that one is born with or cannot alter. Nevertheless, it is important to be aware of risk factors you cannot change so that steps can be taken to reduce loss of bone mineral. 1. Have either of your parents been diagnosed with osteoporosis or broken a bone after a minor fall (a fall from standing height or less)?*YesNo2. Did either of your parents have a stooped back (dowager's hump)?*YesNo3. Are you 40 years old or older?*YesNo4. Have you ever broken a bone after a minor fall, as an adult?*YesNo5. Have you fallen more than once in the last year or do you have a fear of falling because you feel frail?*YesNo6. After the age of 40, have you lost more than 3 cm in height?*YesNo7. Are you underweight (is your Body Mass Index less than 19 kg/m2)?*YesNo8. Have you ever taken corticosteroid tablets (cortisone, prednisone, etc.) for more than 3 consecutive months (corticosteroids are often prescribed for conditions like asthma, rheumatoid arthritis, and some inflammatory diseases)?*YesNo9. Have you ever been diagnosed with rheumatoid arthritis?*YesNo10. Have you been diagnosed with an over-active thyroid, over-active parathyroid glands, type 1 diabetes, or a nutritional / gastrointestinal disorder such as Crohn's, Celiac or Irritable Bowel disease?*YesNoFOR WOMEN11. For women over 45: Did your menopause occur before the age of 45?YesNo12. Have your periods ever stopped for 12 consecutive months or more (other than because of pregnancy, menopause, or hysterectomy)?YesNo13. Were your ovaries removed before age 50, without you taking Hormone Replacement Therapy?YesNoFOR MEN14. Have you ever suffered from impotence, lack of libido or other symptoms related to low testosterone levels?YesNoB. Your lifestyle risk factors - what you can change These are modifiable risk factors which primarily arise because of diet or lifestyle choices.15. Do you regularly drink more than 2 units of alcohol a day?*YesNo16. Do you currently, or have you ever, smoked cigarettes?*YesNo17. Is your daily level of physical activity less than 30 minutes per day (housework, gardening, walking, running etc.)?*YesNo18. Do you avoid, or are you allergic to milk or dairy products, without taking any calcium supplements?*YesNo19. Do you spend less than 10 minutes per day outdoors (with part of your body exposed to sunlight), without taking vitamin D supplements?*YesNoIf you are interested to know more about this Osteoporosis & Fragility Fracture Risk Test, please click Submit and we will get back to you soon. Understanding Your Answers If you answered "yes" to any of these questions it does not mean that you have osteoporosis. Positive answers simply mean that you have clinically proven risk factors which may lead to osteoporosis and fractures. Ifyou would likefurther information about osteoporosis, please visit the International Osteoporosis Foundation website at www.iofbonehealth.org NOTE This test is intended to raise awareness about osteoporosis risk factors. It is not a scientifically validated test.