| I |
Have Either of your parents broken a hip after a minor bump or fall? |
Yes / No |
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| II |
Have you broken a bone after a minor bump or fall? |
Yes / No |
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| III |
Have you taken corticosteroid tablets (cortisone, prednistone etc.) for more than 3 months? |
Yes / No |
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| IV |
Have you lost more than 3 cm (just over 1 inch) in height? |
Yes / No |
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| V |
Do you regularly drink heavily (in excess of safe drinking limits) ? |
Yes / No |
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| VI |
Do you smoke more than 20 cigarettes a day? |
Yes / No |
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| VII |
Do you suffer frequently from diarrhoea (caused by problems such as celaic disease or Crohn's disease)? |
Yes / No |
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| VIII |
For Women: Did you undergo menopause before the age of 45? |
Yes / No |
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| IX |
Have your period stopped for 12 months or more (other than because of pregnancy) ? |
Yes / No |
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| X |
Have you ever suffered from impotence, lack of libido or other symptoms related to low testosterone levels? |
Yes / No |