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)

Smoking

Yes No

Informed Consent

Trauma

Yes No

Spondyloarthropathy (SPA)

Yes No

Rheumatoid Arthritis

Yes No

Diabetes

Yes No

Bronchial asthma

Yes No

Calcified large arteries

Yes No

Renal disease

Yes No

HCV

Yes No

HBV

Yes No

Hyperthyrodism

Yes No

Hyperparathyrodism

Yes No

Medications

GCs

Yes No

Thyroxine

Yes No

Cyclophsophamide

Yes No

PPI

Yes No

Other drugs

Date Of Hip Fracture

Complications

Type of operation done