Name

Birth Date

Age

Gender

Male Female

Residency

--< Select >-- Cairo Giza Alexandria Port Said Suez Demiatt Dakahlia Sharkia Qalyoubia Kafr Shaikh Gharbia Menouffia Behaira Ismaillia Beni Suif Fayoum Minia Assuit Sohag Qena Asswan Luxor Al Bahr Al Ahmar Al Wadi Al Gaddid Matrouh N. Sinai S. Sinai Other Country

Occupation

Weight (kg)

Height (m)

BMI (Body Mass Index)

Veil

Veiled Semi-vieled Completely vieled

Smoking

Yes No

Informed Consent

SLE

Yes No

Rheumatoid Arthritis

Yes No

Spondyloarthropathy (SPA)

Yes No

Liver disease

Yes No

Cardiovascular diseases

Yes No

HCV

Yes No

HBV

Yes No

Alcohol

Yes No

Premature gray hair

Yes No

Calcified large arteries

Yes No

Cancer prostate

Yes No

Bronchial asthma

Yes No

Diabetes

Yes No

Hyperthyroidism

Yes No

Hyperparathyroidisim

Yes No

Renal disease

Yes No

Medications

GCs

Yes No

Thyroxine

Yes No

Cyclophsophamide

Yes No

PPI

Yes No

Other drugs

History of Vertebral fracture

Yes No

History of Hip fracture

Yes No

History of other fractures

Yes No

Point vertebral tenderness

Yes No

Decreased Height

Yes No

Vitamin D (ng/ml)

PTH

TSH

Free T3

Free T4

Calcium (Total)

Calcium (Ionized)

Phosphrus

Urea

Creatinine

Creatinine Clearance (CCl)

Serum uric acid

SGPT

SGOT

Alkaline Phosphatase (ALP)

Testosterone

Estrogen

Prostatic Specific Antigen (PSA)

Positive Negative

L1 - L4 T-Score

L1 - L4 Z-Score

Limb side

Right Left

Radius Total T-score

Radius Total Z-score

Limb side

Right Left

Neck T-score

Total T-score

Neck Z-score

Total Z-score

Result Interpretation

Normal Osteopenia Osteoporosis Severe Osteoporosis

Calcium

Yes No

Vitamin D

Yes No

Bisphosphonates

Alendronate Ibandronate Zoledronate Risedronate

Teriparatide (Forteo)

Yes No