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Cleveland Clinic Orthopaedic & Rheumatologic Institute

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Osteoporosis Evaluation & Assessment

1. What is your current age?

    		 Take the number in shaded area,
multiply by 3, and enter		 ______ Start
2. What is your race or ethnic group? (Check one.)      
  African-American/
Black American    		 Enter 0    
    Enter 5    
  Hispanic     Enter 5    
  Asian     Enter 5    
  Native America /
American Indian     		Enter 5    
  Other     Enter 5 ______  
3. Have you ever been treated for or told you have rheumatoid arthritis?

Yes     No    		 If yes, enter 4 ______  
4. Since the age of 45, have you experienced a fracture (broken bone) at any of the following sites?      
  Hip Yes     No     If yes, enter 4 ______  
  Rib Yes     No     If yes, enter 4 ______  
  Wrist Yes     No     If yes, enter 4 ______  
5. Do you currently take or have you ever taken estrogen? (Examples include Premarin, Estrace, Estraderm and Estratab.)
Yes     No    		 If no, enter 1 ______  
Add score from questions 1-5   ______ Subtotal
6. What is your current weight?

       		 Take the numbers in shaded area and subtract from subtotal ______ Subtotal
If your final score is 6 or greater, you should be evaluated further for osteoporosis. Talk to your doctor. Final
Score