Osteoporosis and Fracture History Form

This comprehensive osteoporosis and fracture history form is designed for healthcare providers who manage bone health and osteoporosis prevention. It systematically documents all major risk factors for osteoporosis including age, gender, previous fractures, family history, hormonal factors, medications that affect bone density, and lifestyle factors like calcium intake, vitamin D supplementation, and weight-bearing exercise. The form includes detailed questions about previous fracture locations, circumstances of injury, and healing outcomes.

The template is essential for rheumatologists, endocrinologists, geriatricians, and orthopedic specialists who need to assess fracture risk and determine appropriate screening intervals for bone density testing. It captures information about menopause history, steroid use, thyroid conditions, and other secondary causes of bone loss. By documenting fall history and risk factors, the form also supports comprehensive fall prevention planning and helps providers determine candidacy for osteoporosis medications like bisphosphonates or biologics.