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1Dateentered(officeuseonlY) mm

THEUNIVERSITYFMELBOURNEONERESEARCHPROGRAMDepartmentf General Departmentf Medicine centre orpractice andpublic Health Royal Melbourne Hospital GeneticEpidemiology

WHETHER EGULAR ABLETENNISACTIVITYSASSOCIATED ITHINCREASED ONEANDMUSCLE TRENGTHND MPROVED ALANCEINOLDER SIANMENANDWOMEN

HEALTH NDDIETARY UESTIONNAIRE

we would ikeyou o fill nthesequestionnairessbestyoucanandanyproblemscanbediscusseduring our nterview.Please ompletentheweekprioroyourvisit.Thank ou orparticipatingn hisproject.

Date fVisit:O"y Tl Month

BoneResearch rogram, epartmentf Medicine,RoyalMelbourne ospital, arkville, IC3050.Ph: 03 83446882.Fax: 0393482254.

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Thisquestionnaires designedo covervarious gegroups.Somequestionsmaynot seem elevantoyou,butplease o attempto answer ach elevant ection.

Monthsmmulm

Years

B).8.1

Self:Father:Mother:

8.4 GitizenshipSelf:Father:Mother:

A). PERSONAL ATAA3. Dateof Birth:A.4 CurrentAge:A.5 Education:Howoldwereyouwhenyou eftschool r othereducation?Howmanyyearsdidyouspendn school:

Primary nd Secondary?Technical ollege?University?

EthnicityData:Placeof birth:Country State

Self:Father:Mother:B.3 Year of Migration o Australia if not born in Australia):

City/Province

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3

What do you consider o be your ethnic origin?nltr speciry:

A.9 MainLanguage poken:First anguage:At Home

zNo

Secondanguage:At work/school

c). FAMTLYDATACl. Do any of your close relativeshavea tendency o break heir boneseasily?

I | . Don'tknowI rYes+2. Which of your relativeshave

n Mother|-] Brothertl Grandmother

GOTO QUESTION 3GOTO QUESTION 3

C3.Has a doctor ever diagnoseda family member bloodrelative)with osteoporosis?

broken heir boneseasily?I Father I sistern Aunt I UncteI Grandfather I other

l-l, r'ro E . Don't now Yes:FORRESEARCHERSSEONLY

Other

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D). MEDTCALTSTORYDI. Please ist any presentor pastoperations,llnessesor accidents anddates hey occurred).

FORRESEARCHERSSEONLY

D2. you brokenanybonesin the past?zNo GOTO SECTION

GOTO SECTIONDon'tknow1 Yes+

Tick the boxescorrespondingo the sites that any racturesoccurred n your life.

EEEEEtrtrn

HaveTnnSITEFOREARMWRISTFINGERLEGHIPANKLETOEBACKOTHER:-

AGE(s) How was it brokenRIGHTLEFTRIGHTLEFTRIGHTLEFTRIGHTLEFTRIGHTLEFT

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SMOKINGHABITSHaveyou ever been a regularsmoker e. smokedon averageat least sevencigarettesperweek orat feast ayear ?L ruo' Go to SECTION

I, "=s Howold wereyouwhenyou irstsmokedat leastsevencigarettes week orm Yearsat leastoneyear?Please ill out the followingable. Startat the 10 -19 yr age rangeand continue until yourcurrent age. Just write "0" if yotr smokednone or less than 7 cigarettesper week.Age range

Howmanyyearsdidyousmoke egularly(ie.Smoked naverage tleastseven igarettes erweek?)

Duringhose ears, naverage, ow manycigarettesperdidyousmoke?

10 19years Years ru Cigarettes/day20 - 29years Years ilI Cigarettes/day30 - 39 years Years t= Cigarettes/day40 - 49 years Years E; Cigarettes/day50 - 59 years Years [: Cigarettes/day60 - 69 years Years == Cigarettes/day70 - 79 years Years il Cigarettes/day80- 89years Years CI Cigarettes/day90 - 99years Years Frr.lrlI I Cigarettes/day

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D.Fl.

MENSTRUAL EPRODUCTIVEISTORYHaveyou hadyour first menstrualperiod?[-l , *o[l , ""r+F2. How old wereyou whenyou hadyour first menstrualperiod?

II vears m months

GOTO SECTION

F3. What was the date of your !!!gg!_fece$ menstrual period (does not include spotting,breakthrough leedingor bleedingwhile usingHormoneReplacement herapy HRT))?Day:m Month: Year:

t]] vears m monthsF4.How old wereyou whenyou last had a period?

F5. Haveyour periodschanged n frequencyor stopped?l\ ln GOTO F7Yes(changedn frequency) GO TO F6Yes(ceased) + GO TO F6

TlI

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,i l-]llll Menopausechange f ife)Medical ondition Whatwas t called?Weight oss/stress/ravelRemoval f bothovaries,without ysterectomyHysterectomy+

date:__l-J----)

Ll Medicationse IV

Don't now

I

F6. Give he reason(s)why you believeyour periodshavechanged n trequencyor stopped.

TTnl ( Wereovariesemoved t the imeof hysterectomy?fl on" ovaryemoved NoovariesemovedI t*o ovariesemoved n Unsurefovary tatus

What s he name f themedicationhatcaused ourperiodso stop?..Howoldwereyouwhenyoubeganusing t? I | | years I | | monthsHowong aveoubeen singt or, n otal?m weekstI ton,r*lTl yearsWhatwas t prescribedor?nll Treatment f menopausalymptoms/menstrualrregularitiesue o menopause[-] contraception

Other easonplease pecifY):

tll-J Other easonpleasepecify).............

Version

GOTO QUESTION7

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OVERTHELASTYEARNOTE: lf your last periodwas more than 12 months ago,you do not need o complete his

section.Go to F16F7. Over he lastyear,what was the average ime between he first day of one periodand the firstdayof nextperiod? I I I ldaYsF8. Overthe last year,what was the maximum ime between he first day of one periodand thefirst dayof the nextperiod?

F9. Over he lastyear,what was the minimum ime between he first dayof oneperiodand he firstday of the nextperiod? daYsF10.Over he tastyear,what was the averageamountof bleeding?

I t small [-], moderate-lt heavy/clotsFl1. Over he astyear,

II padsF12.Over he tastyear,what was the averagenumberof days eachperiod asted?

m davsF13.Howmanyperiods ave ouhad nthepastyear? tIF14.Overthe past year, haveyou taken any medication,which would affect he reqularitvol youperiods?|__] No [-] Yes,HRr l-l v"r, contraceptiveill l-l Yes, therF15. Over he lastyear,haveyour periodsbeen egularor similar o previousyears?

Yes GOTO F22Juststarted etting eriods

whatwas he average umber f pads/tamponssedperperiod?| | I tampons

Version

No GOTO Fl6GOTO F24

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THINKING BOUTTHEYEARSDURINGWHICHYOUHAVEHADPERIODS

F16. What wasperiod? the gyre time between he first day of one period and the first day of nextl-I-[l o"u.F17. What was the maximum ime between he first day of one periodand the first day of the nextperiod?

daysF18. Whatwas the minimum ime between he first day of one periodand the first day of the nextperiod?

daysFl9. Whatwas he average mountof bleeding?

r small I, moderate I . heavy/clotsF20. What was the averagenumber of pads/tampons sedper period?

Inpads tI tamponsF21. What was the averagenumberof day eachperiod asts?

Inegufarperiodsorecotnffion ffion7 outtguofilenarufwuaffy [o nat*rpt! any abnonno.fity

F22. Has there ever been a time when you had less than five periods in one year (excludingpregnancy,breastfeeding r menopause)?t--t1_l a NoorDon' tkno# GOTOF2Sr Yesl

YF22a. How manyperiods,on averagedid you haveeachyear?F22b. For how manyyearsdid you have ess than 5 periods?F22c. Whatwas the reason?

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10F23. Have your periods ever stopped for more thanbreastfeeding r going hrough menopause? 2 months when you were

tll[l , No co ro F24

s Don'tknow-) GOTO F24I , t " tJ

F23a.How anyimesdid his occur? m timesF23b. n average,ow ongdideachepisodeast? Il months

F23c.What do you thinkwas the reason(s)?l_l oooroachingenopause-| stresstravell_l ,os orweisht n lllness/medicalcondition

Other eason

F24. Haveyou everused he contraceptive ill ?zNo GOTO F25

Ll 3 Don't now GOTOF251 Yes: brand(s)IF24a.At whatagedidyou irst use hepitt? m years m months

F24b.In otat, or how onghave ou aken hepitt? m years t]] monthsF24c.Areyoucurrenttv sing he contraceptiveill? I Yes I No

MedicationDon'tknow

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11HaveyoueverusedHormoneReplacement herapy HRT)?

F25a.F25b.

l l z No#GOTOF26Ll g Don'tknow---4 GOTO F26

r Yes brand(s):JAt what agedid you first use HRT?What was the reasonyou commencedHRT?

F25c. In total, or how long haveyou takenHRT?F25d. Areyou eurrentlvusing HRT? | | V".

F26. Haveyou ever beenpregnant?zNo GOTO SECTIONG

I I r Don'tknow GOTOSECTIONGE,Yesl

,Jgn"n"i"shave ouhad hat asted eyond 0weeks?ruF26b.Howmany hitdren ave ouhad? m

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L2F27.Pleaseill in the ollowing ableabouteachof yourchildren.

Dateofbirth ofchildCalcium upplementsduringyour pregnancy? Number fmonthsbreast ed

Galcium upplementswhile you were breastfeeding?

Yes No Don'tknow Yes No Don'tKnow1stCHILD2nd CHILD (_t_t_)3rd CHILD (J-r-74th cHtLD (_t_t_)sth cHtLD (_/_/_)6rh GHILD (_tJ_)7th cHtLD (JJ-\8th CHILD (JJ-)gth CHILD (_tJ_)1oth HtLD (_t_t__)

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TTT

13G. MEDICALHISTORYGI. Please hink aboutany currentor pastmedical onditions ou may havehad. We will askyouto give details(suchas when t was diagnosedand any reatment eceived)at the interview.G2. Haveyou ever been reated or bonedisease?

NoDon't knowYES Whatwas thedisease alled?

G3. Are you currently,or haveyou ever aken any of the following medications? please ick)Medication Currently Ever CommentYes No Don'tKnow Yes No Don'tknowThyroid ormone

Oestrogensfemale ormone,ther hanthecontraceptiveill).Brand:Dose:Duration:CombinedOestrogen Progestogen(other han hecontraceptiveill)Brand:Dose:Duration:Progestogen loneBrand:Dose:Duration:OralContraceptiveill:Brand:Dose:

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Cortisone-like edicationl inhaledI topical- creamItabletsAnabolic teroid tobuildup bone/muscle)Androgenssexhormones)Calcitoninhormonereatmentor bonedisease e.q. Paqet'sdiseaseAnti-convulsantsThiazide iureticswater r fluid ablets)Tick f for hypertensionseNon{hiazide iureticsTick f forhvpertensionseAnti-hypertensionedicationnotCalciumSupplementotherhan orpregnancyr breastfeeding)

Bisphosphonatetreatmentor bonedisease .o. Paoet's isease

Mineralse.9. ron, inc,magnesium):

Asthmamedication:Brand:

Non-steroidal nti-inflammatorymedicationWarfarin/HeparinVersion

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Medication

Over hecounteremedies,g:herbal,promensil

Traditional edicine

OtherMedicationsbrand/dose/duration)

H. OCCUPATIONALISTORYHl. Areyoucurrentlyn paidemployment? ESff9- *oIlf yes,please escribeour urrentmainoccupation............ .....Goo H2.Hl.a Pleasedescribeyour husband'sor parents'mainoccupations seebelow).lf theyare retired,pleasedescribe heir main occupationprior o retirement.lf no + lf youarea housewife,hat syourhusband's ainoccupation?

-+ If youare under18yearsof age,whatareyourparents'mainoccupations?Father 'sccupation... . . .Mother 'sccupation... . . .

SeeH1.a

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BELOWARE3 GROUPSOFOCCUPATIONALDAILYACTIVITIESlncl.volunteerwork)Group1: Predominantlysitting e.g. desk work, factorywork (mainlysitting), eception,cashier, omputer rogrammersitting), tudent, olunteermainly itting) tc.Group2: Predominantlystanding, some walking e.g. bank teller,generalofficework,physiotherapist,actoryworkwithstanding ndsome ifting, ouseduties, tc.Group3: Predominantly ctivee.g.aerobicseacher, omestic leaner, urse patient are),work involving eavy ifting,waiter,dancer,caring or children active), olunteer(active), tc.

AGEat start(vears) DURATION(months) GROUP COMMENTS(hrs/week)Current

H2. Please ill in the following ablereferring o your CURRENT ccupation/daily ctivity.

(a)Pleaseelaborateon the typeof activitycurrentlyperformed e.9.how much lifting/walking):

H3.What syour otalnumber f working ears nyour ifeup untilnow?Pleasecomplete he following table about your !l\$ occupations/daily ctivity of more than twoyearsduration:

JOB AGE at start(years) DURATION(months) TYPEof ob GROUF(1.2or3) COMMENTS(hrs/week)1tt2nd3"t4th5t^6th7thgtngthH4. On average,how many hours perweek do you do householdworke.g.vacuuming,crubbing athrooms,anging utwashing,awnmowing,gardening,ooking nd roning tc.

ul

activities?ulVersion4 tu06to1

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t7r.)DrET1.1.Areyou CURRENTLYr haveyou EVER ollowedany specialdiet for medical easons(eg.Diabetes, llergy,high cholesterol)?

No - Go o question .3! "" . - Go o next uestion.

a.2. F you are CURRENTLY,r haveEVERbeen on a specialdiet for medical easons eg.Diabetes, llergyor high cholesterol)OR n orderto slim,OR f you are vegetarian, leasegive he following nformation.Reasonor diet Dietary hangesmade

1.3 Please ank your use of the following milks in increasinqorder with "1" denoting hemost frequentlyused milk, "2" denoting he secondmost frequentlyused milk, etc. Markany milks not used at all with a "0".

I wholemitk I Revmitk I Physical SkimmilkI soymilk I other pleasepecify):1.5Please tateyour reasons, f you do not drink milk?

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I.6MILK NTAKEThe ollowing uestionselateo yourpast ntake f milk.

Place lineon hescaleof CUPSOF MILKPERDAY onecup s250mL). lndicate yplacing strokethrough he ine o indicatehe DAILYTOTALestimatedmount f milk akenduringdifferent eriods fyour ife. (lt canhelp f you ry o visualiseourday o day ifeas t was hen, heplace ouwere iving,andwhere ouwereworking r went o school).

1.7 At the present imeI ' l ' l ' l ' l ' l ' l ' l ' l 78

cups of milk/day1.8 Two yearsagol ' l ' l ' l ' l ' l ' l ' l ' l012345678r.g rf aged over 30,10 yearsago cupsof milk/day

I ' l ' l ' l ' l ' l ' l , l ' l 78cups of milk/day1.10 lf you havehad children,duringpregnancyl , l ' l ' l ' l ' l ' l ' l , l 78cups of milk/day1.11 lf you havebreastfed hildren,duringbreastfeedingl ' l ' l ' l ' l ' l , l ' l ' l 78cups of milk/day1.12 lf agedover30,duringadolescencewhilstat high school)l ' l ' l ' l ' l ' l ' l ' l , l012345678 c'upsof milk/day1.13 During hildhood whilstat primary chool)l ' l , l ' l ' l ' l ' l ' l ' l 78cups of milk/day

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L9

you hadat least12 drinksol any kind of alcoholicbeveragesn yourentire ife?

DURING HEPAST12MONTHSDidyou haveat least 12 drinks of any kind of alcoholic beverage uring he last12 months?

lf yes,please il l in this table:

fill in this table:ALCOHOL NTAKEDURING HE LAST12 MONTHSBeer(7oz)-210mWine(4oz)-120m

Spirits(mixeddrinks)

Have herebeen imes n your life since he age ofconsumptionasbeengreatly ifferenthan hepast12YesNo

yourfirst socialdrinkwhenyour alcoholmonths?

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DO NOT COMPLETE - OFFICB USE ONLY

MEDICALCONDITIONS Yes No Don'tknow Gomments(age,etc)GastrectomyPartof stomachemovedMalabsorptionyndromechronic owel iseaseOtherboweldisease:Diabetes/ugarn he urine NIDDM IDDM)Gestational iabetesRheumatoidrthritisOsteo-arthritisOtherarthritis:AsthmaOsteoporosisOsteomalaciaRicketssoftbones)Secondary menorrhoeaCushing's yndromeHyperthyroidismoveractivehyroid)Hypothyroidismunderactivehyroid)PrimaryHyperparathyroidismhighblood alcium)Kidney isease r kidney tones:Liver isease:Spinal urgery r chronic pine iseaseSignificantackor neckmusculo-skeletalroblemSignifcantmusculo-skletalproblem ffecting artofthe eg arm:Cancer:Epilepsy:HypertensionGestationalypertensionHeartDisease:Hypercholesterolemiahigh holesterol)Prolonged eriodof immobilizat ion:-Under-nutritionorsignificant|ossofweight:-NeurologicalroblemsbraindamageStroke HemiplegiaOther

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A). PERSONAL ATAA1. Name:

(Surname)A2. HomeAddress:

(Othernames)

Postcode:ContactPhoneNo. Daytime:-)lF UNDER 8YEARSOF AGEPLEASECOMPLETEHEFOLLOWING:-C4. Mother'sName:C5. HomeAddress:

(Surname) (Other ames)

Postcode:ContactPhoneNo. Daytime:G6. Father'sName:

Evening:(Surname) (Other ames)

G7. HomeAddress:Postcode:

ContactPhoneNo.Daytime: Evening:(lf it's the sameput "as before")

THANK-YOUORCOMPLETINGHEHEALTH UESTIONNAIRE.

Evening:_)_