What is your current age?
Take the number in shaded area, multiply by 3 and enter
2.
What is your race or
ethnic group?
African-American/Black American, enter 0
Caucasian, Hispanic, Asian, enter 5
Native American/American Indian, enter 5
3.
Have you been treated
for or told you have rheumatoid arthritis?
If yes, enter 4
4.
Since the age of 45,
have you experienced a fracture (broken bone) at any
of the following sites?
Hip - if yes, enter 4
Rib - if yes, enter 4
Wrist - if yes, enter 4
(4 for
each, enter up to 12)
5.
Do you currently take
or have you every taken estrogen?
(Examples include Premarin, Estrace, Estraderm, and
Estratab)
If no, enter 1
Add score from questions 1-5
6.
What is your current
weight?
Take the numbers in shaded area and subtract from
subtotal
If your final score is 6 or greater, you should be
evaluated further for osteoporosis. Please talk to your
doctor.
