The following are the risk factors for fall and fracture.
Please put a 
in the appropriate box. The more ticks you put mean the higher the risk of fall and fracture.
Personal factors
| -Female |
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| -Age 50 or older |
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| -Early menopause |
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| -Thin bone |
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| -Become shorter and humpbacked |
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| -Have a family history of osteoporosis |
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Habitual factors
| -Insufficient exercise |
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| -Smoking |
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| -Drinking alcohol |
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| -Always drinking of coffee or dark tea |
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| -Love salty food |
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| -Insufficient calcium and vitamin D in the diet |
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| -Trousers become longer |
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| -Sole of the footwear become slippery |
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Medical history
| -Had fall history |
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| -Parkinson's Disease |
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| -Stroke |
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| -Cataract |
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| -Bed bound due to long term illnesses |
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Medication
-Medicine listed below may cause fainting or unconsciousness
E.g. Sleeping pills, pain killers, tranquilizers, anti-hypertensive drugs and hypoglycemic drugs |
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-Medicine listed below may cause osteoporosis
E.g. Steroid, parathyroid hormone and etc. |
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Home environment
| -Wet and slippery floor surface |
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| -Obstacles on the floor |
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| -Inadequate lighting |
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| -Wearing of chair |
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| -No appropriate hand rail beside the bed or in the washroom |
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| -Unsmooth floor surface |
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