1. What is your gender?
   Female      Male
2. How old are you?
   35 years or less    36-44 years    45-60 years    61 years or more
3. If you are female, did you go through menopause or did you have your ovaries surgically removed before you were 50 years old?
   Yes    No
4. If you are female and postmenopausal, are you taking estrogen?
   Yes    No
5. Have your relatives had osteoporosis, or have they suffered hip, shoulder or wrist fractures, or lost height after the age of 45?
   Yes    No
6. What is your ancestry?
   African - American    Asian    Caucasian    Other
7. How do you consider your weight?
   about normal weight    very overweight    very thin
8. Do you consider your body frame (based on your bone structure) to be:
   about average    definitely large-boned    definitely small-boned
9. Do you smoke?
   Yes    No
10. Do you engage in regular exercises in which bone and muscles work against gravity, like walking, jogging, stair climbing, racquet sports and team sports?
    at least 3 hours per week    less than 3 hours per week    hardly any or none
11. How often do you consume calcium-rich foods such as broccoli, milk, cheese, yogurt and canned sardines?
    several servings per day    one or two servings per day    not very often
12. Do you take calcium?
    Yes    No
13. Have you been taking corticosteroids for 6 months or longer?
    Yes    No
14. Do you take anticonvulsants?
    Yes    No

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