Nutritionist Seema Singh

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OSTEOPOROSIS RISK ASSESSMENT FORM

Medications:

Do you have family history of osteoporosis?

Do you smoke or take tobacco?

Do you drink alcohol?

Do you exercise?

Is your diet low in dairy products & other sources of calcium?

Are you a postmenopausal woman?

Have you had other fractures since age 50?

Have you lost more than 2” of height since high school?

Do you take thyroid medications regularly?

Do you take prednisone or other steroids regularly?

Thank you for taking our survey.

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