Patient’s Medical History

Personal History

History of gallbladder removal

I have a sedentary lifestyle

History of gallbladder disease

Tobacco use: present or past

History of a liver problem

I have lost over an inch of height

I have a history of a kidney stone

I’ve had a spine fracture

I have a history of over-active thyroid

I’ve had a wrist fracture

I have a history of under-active thyroid

I’ve had a hip fracture

I’ve had a rib fracture

I have a history of blood clot

I’ve had a pelvic fracture

I have a history of pulmonary embolism

I’ve had a stress fracture

I have a history of high blood calcium

I’ve had a fracture not listed

I have a history of osteoporosis

I have a Dowager’s hump of the spine

Family history of osteoporosis

I’ve had chronic diarrhea

I have a history of alcoholism

I have back pain

3 or more alcoholic beverages/day

I have a history of multiple myeloma

I’ve had Crohn’s Disease

I’ve had lower back surgery

History of adverse reaction to Etidronate

I’ve had billary cirrhosis

I’ve had Paget’s disease

History of adverse reaction to Alendronate

I have rheumatoid arthritis

I’ve had chronic renal failure

Female Reproductive System History

Menopause before age 45

I have uterine fibroids

Past menopause

I had a hysterectomy

Loss of period for 6 months or more

I’ve had cervical or uterine cancer

Onset of periods after age 16

I have fibrocystic breast disease

I lost periods due to heavy exercise

I have a history of breast cancer

I had my ovaries removed

I have a family history of breast cancer

History of irregular periods

I have a history of amenorrhea

Medication History

I have used cortisone-like drugs

I have used thyroid hormone pills

I use Mylanta or Maalox often

High Prolactin levels

Treatment with Estrogen

History of adverse reaction to Raloxifene (Evista)

I’ve taken oral steroids (Prednisone) for more than 8 weeks

I have used phenobarbital or phenytoin (Dilantin)

Long-term treatment with inhaled steroids

Special Medications History

I’ve had chemotherapy

I’ve been treated with Lithium

I’ve been treated with Lasix

Long time use of Tetracycline

Treatment with Fosamax

Prolonged use of anticoagulants

Treatment with Actonel

I’ve had insulin dependent diabetes

I’ve been treated with Tamoxifen

Diet and Exercise History

I usually eat meat twice daily

I don’t exercise regularly

I follow a vegetarian diet

I use 3 or more soft drinks daily

I have a diet rich in dairy foods

I use 3 or more cups of coffee or tea daily

I avoid milk and other dairy foods

History of anorexia nervosa or bulimia

Special Conditions

History of partial or total Gastrectomy

Estrogen therapy after menopause

History of Leukemia

History of Klinefelter’s syndrome (low testosterone)

History of Hypercalcemia (too much calcium)