Fracture Risk Assessment Tool

Name

Date of birth

Sex

 
 

Weight (imperial)

Height (imperial)

Have you had a previous fracture?

 
 

Have you had a hip fracture

 
 

Do you currently smoke?

 
 

Steroids - Enter yes if you are currently using or used for more than 3 months Prednisolone 5mg daily (or more or equivalent glucocorticoids)

 
 

Rheumatoid Arthritis - Enter yes if you have a confirmed diagnosis of Rheumatoid Arthritis (not osteoarthritis)

 
 

Secondary Osteoporosis - Do you have or have you had any of the following conditions

 
 
 
 
 
 

Alcohol - Enter yes if you take 3 or more units of alcohol daily. (equivalent to half a pint of beer or lager, a single measure of spirts (30ml), a medium sized glass of wine (120ml) or 1 measure of an aperitif (60ml)