Have you lost more than 2 inches in height? | Yes | No |
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Have you ever broken a bone? (list your age, date, and circumstances for every fracture below) | Yes | No |
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Does your mother, father, brother, or sister have osteoporosis? | Yes | No |
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Has your mother, father, brother, or sister broken bone since age 40? | Yes | No |
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Do you smoke cigarettes? | Yes | No |
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Do you have more than two drinks of an alcoholic beverage per day? | Yes | No |
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Do you weigh less than 127 lbs? | Yes | No |
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Do you have rheumatoid arthritis? | Yes | No |
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Do you have kidney failure? | Yes | No |
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Have you had vitamin D deficiency? | Yes | No |
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Do you have lactoce intolerance? | Yes | No |
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Any difficuly with digestion? | Yes | No |
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Have you ever had hyperthyroidism (an overactive thyroid gland)? | Yes | No |
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Have you had hyperparathyroidism, or a high calcium level in your blood? | Yes | No |
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Do you have inflammatory bowel disease, such as Crohn's disease? | Yes | No |
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Do you have intestinal malabsorption, such as celiac disease? | Yes | No |
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Have you had a gastrectomy (part of your stomach removed)? | Yes | No |
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Have you ever had an eating disorder? | Yes | No |
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Have you had an organ transplant? | Yes | No |
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Have you fallen in the last year? | Yes | No |
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Do you have a walking or balance problem? | Yes | No |
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Do you have to push off on the arms of a chair to stand up? | Yes | No |
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Do you have any problems with infection or pain in your teeth or jaw? | Yes | No |
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Do you have any oral surgery or tooth extractions planned or scheduled? | Yes | No |
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Do you have any ongoing problems with your teeth or jaw? | Yes | No |
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Are you allergic to any medicines? (list below) | Yes | No |