Smart Behavior Osteoporosis Risk Factor Profile.

To help determine your risk of osteoporosis, circle the number next to the statement in each category that is most true for you.
Add up the points when you have finished the entire profile.

This questionnaire will soon be interactive. Until then you can print it and tabulate the results of your responses on hard copy.

Age:
	Under 35           1
	35-50              3
	51-65              7
	Over 65            12

Heritage:
	African-American                    1
	Asian                               2
	Mediterranean or Middle Eastern     3
	Caucasian                           5

Complexion:
	Dark               1
	Ruddy/Olive        2
	Fair/Pale          3

Family History:
	No known bone problems in family        1
	Relative over 60 with bone disease      3
	Parent with bone disease                4
	Relative under 60 with bone disease     5

Wrist size:
	Over 6.5"          1
	6" - 6.5 "         2
	5" - 6"            3
	Under 5"           4

Height:
	Over 5'8"          1
	5'5" - 5'8"        2
	5'2" - 5'5"        3
	Under 5'2"         4

Body type:
	Mesomorphic- high muscle, low fat       1
	Endomorphic- high fat, low muscle       6
	Ectomorphic- low fat, low muscle        6

Onset of Menopause:
	After age 50                            1
	Age 46-50                               3
	Age 45 or under*                        5
	Surgical menopause age 45 or under      7

* deduct 5 points if estrogen therapy was started within one year after surgery or early menopause.  Deduct 3 points if
started more than three years after surgery or early menopause.

Genetic Score _________

Lifestyle Factors

Exercise (total body):
	4 or more time a week          0
	1-3 times a week               3
	At least 3 times a month       6
	Avoid physical activity        12

Calcium Intake:
	4 or more servings of low-fat dairy		
	products a day                       0
	More than 2 servings a day           3
	2 or less servings a day             6
	Avoid dairy products                 12

Protein Intake:
	Avoid red meat                            0
	Eat only seafood and white meat poultry   1
	Eat meat 3 times a week or less           3
	Eat meat 4 times a week or more           6

Caffeine Consumption:
	Avoid caffeine and tannin beverages       0
	Decaffeinated drinks and/or tea only      2
	3 cups or less of coffee/tea daily        3
	4 cups or more coffee daily               6

Alcohol Consumption:
	Less than 
	 2 beers, 8 oz wine
	3 oz. of spirits per week           0
	2-4 beers, 8-16 oz wine or
	3-6 oz spirits per week             2
	Up to 2 beers, 8 oz wine or
	3 oz spirits per day                4
	More than 2 beers, 16 oz wine	
	or 6 oz spirits per day             8

Tobacco Use:
	Non smoker                              0
	Less than 14 cigarettes per week        2
	Less than 10 cigarettes per day         5
	10 cigarettes or more per day           8
	
Lifestyle Score_____________

Genetic Score______________

Total Score________________

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