Are You at Risk?

Men - risk assessment questionnaire

• Have you broken a bone in the past five years?
  Yes No
  
  
• Do you suffer from back pain and/or height loss of more than 2 inches/5 centimetres?
  Yes No
  
  
• As far as you are aware, did your mother ever suffer from symptoms of osteoporosis, such as a broken hip?
  Yes No
  
  
• Have you ever had anorexia?
  Yes No
  
  
• Do you, or have you previously smoked cigarettes?
  Yes No
  (If yes, roughly how many per day?)
  
  
• On average, do you drink more than 21 units of alcohol per week?
  (1 unit is equivalent to ½ pint of beer, 1 small glass of wine, 1 standard glass of sherry or 1 measure of spirits).
  Yes No
  
  
• On a scale of 1 to 10, how physically active are you? (please circle a number below)
  

  Inactive									Very Active
  1	2	3	4	5	6	7	8	9	10

  
  
  
• Have you ever suffered from Crohn's disease or Coeliac disease?
  Yes No
  
  
Are you taking any of these?
a. Steroid tablets
(e.g. prednisolone) Yes No

b. Thyroid hormone
(e.g. thyroxine) Yes No

c. Treatment for epilepsy
(e.g. phenytoin) Yes No


• Have you experienced symptoms of low levels of testosterone like a loss of libido, loss of erection, depression and fatigue?
  Yes No

If you answered 'yes' to several of these questions, you may be at risk of osteoporosis but this does not necessarily mean that you have osteoporosis.

You may wish to print your completed questionnaire and take it to your doctor at your next appointment. Remember that the risk of developing osteoporosis can be reduced by taking appropriate preventative measures (such as diet and lifestyle changes) and through early diagnosis and treatment.



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