1. Have either of your parents been diagnosed with osteoporosis or broken a hip after a minor bump or fall?
Yes No

2. Have you broken a bone after a minor bump or fall?
Yes No

3. Have you taken corticosteriod tablets (cortisone, prednisone,etc) for more than 3 months?
Yes No

4. Have you lost more than 3 cm (just over 1 inch) in height?
Yes No

5. Do you regularly drink heavily (in excess of safe drinking limits?)
Yes No

6. Do you smoke more than 20 cigarettes a day?
Yes No

7. Do you suffer frequently from diarrhoea (caused by problems such as celiac disease or Crohn's disease)?
Yes No

8. Did you undergo menopause before the age of 45?
Yes No

9. Have your periods stopped for 12 months or more (other than because of pregnancy?)
Yes No