Specify if the patient has ever had any of the following conditions:
Osteoporosis or taken medicine for osteoporosis? Please list. – Select Yes or No.
With Yes selected, a set of responses (Date and Description) is available.
For each additional set of responses you want to add, click Add More. You can add up to four additional sets of responses.
Note: To delete an additional set of responses, click the corresponding Delete button 
.
Optionally, select a year and/or description for each set of responses:
Date - Select a year or Unknown. If a year is selected, to specify that the year is approximate, select the Approximate Date checkbox.
Description - Select one of the following descriptions:
Primary Osteoporosis (Most common-age related).
Secondary Osteoporosis (From med condition).
Paget's Disease.
Osteogenesis Imperfecta.
Idiopathic Juvenile Osteoporosis.
Current Osteoporosis Medications: None.
Current Osteoporosis Medications: Oral Bisphosphonate.
Current Osteoporosis Medications: Injection/IV Bisphosphonate.
Current Osteoporosis Medications: Alendronate (Fosamax).
Current Osteoporosis Medications: Ibandronate (Bonivia).
Current Osteoporosis Medications: Zoledronic Acid (Zometa).
Current Osteoporosis Medications: Risendonate (Actonel).
Current Osteoporosis Medications: Vitamin D.
Current Osteoporosis Medications: Calcium.
Other – With this option selected, an Add description box is available. Optionally, enter up to 60 characters.
Joint replacement (hip, knee, ankle, shoulder)? – Select Yes or No.
With Yes selected, a set of responses (Date and Description) is available.
For each additional set of responses you want to add, click Add More. You can add up to four additional sets of responses.
Note: To delete an additional set of responses, click the corresponding Delete button .
Optionally, select a year and/or description for each set of responses:
Date - Select a year or Unknown. If a year is selected, to specify that the year is approximate, select the Approximate Date checkbox.
Description - Select one of the following descriptions:
Hip.
Knee.
Ankle.
Shoulder.
Finger.
Other – With this option selected, an Add description box is available. Optionally, enter up to 60 characters.
Osteoarthritis (i.e. degenerative arthritis)? – Select Yes or No.
With Yes selected, a set of responses (Date and Description) is available.
For each additional set of responses you want to add, click Add More. You can add up to four additional sets of responses.
Note: To delete an additional set of responses, click the corresponding Delete button .
Optionally, select a year and/or description for each set of responses:
Date - Select a year or Unknown. If a year is selected, to specify that the year is approximate, select the Approximate Date checkbox.
Description - Select one of the following descriptions:
Osteoarthritis.
Rheumatoid Arthritis.
Juvenile Arthritis.
Ankylosing Spondylitis.
Systemic Lupus Erythematosus (Lupus).
Gout.
Infectious and/or Reactive Arthritis.
Psoriatic Arthritis.
Fibromyalgia.
Scleroderma.
Other – With this option selected, an Add description box is available. Optionally, enter up to 60 characters.