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Osteoporosis Risk Assessment Tool - Input Form

 

Age:

Weight:

 

 

Menstruation cycle:

Start :

Finish :

 

Have you taken any of the following medication?

Yes

No

Cortisone

Heparine

 

Previous therapy for Osteoporosis?

Yes

No

Aledronati 'Fosamax' or 'Fosavance'

Zoledronati 'Aclasta' or 'Zomeda'

Calcium + Vitamin D