DEXA Scan Questionnaire

M F
Yes
No
Have you had any fractures during your adult life which did not result from significant trauma (e.g., auto accident)?
Did either of your parents ever have a hip fracture?
Do you smoke?
Have you taken Glucocorticoids (steroids) for more than three months consecutively?
Do you have rheumatoid arthritis?
Do you have secondary osteoporosis?
Do you drink 3 or more alcoholic drinks per day?

Do you have any of the following medical conditions?

Anorexia or Bulimia
Asthma or Emphysema
End stage renal disease
Hyperparathyroidism
Any Seizure Disorders
Cancer
Inflammatory Bowel Diseases
Hysterectomy
Other