Vitamin D Deficiency Risk Assessment

This questionnaire has not been validated but is based on known risk factors for vitamin D deficiency

1. Do you regularly have the opportunity to expose your head, hands, and arms in a period of sunshine for circa 20 minutes between 11 a.m. and 3 p.m?
Regularly     Occasionally     Never

2. Do you use sunscreen?
Yes     No

3. Do you have dark skin?
Yes     No

4. Are you over 70 years of age?
< 70 years     70-80 years     > 80 years

5. Do you practice any sport or activity outdoor (at least 3 hours per week)
Yes     No

6. Are you overweight (BMI between 25 and 29.9) or obese (BMI of 30 or more) - BMI : body mass index = kg/m²
Normal weight     Overweight     Obese

7. Do you regularly take vitamin D suplementation or omega 3 fish oil?
Yes     No

8. Do you regularly eat food rich in vitamin D? (egg yolk, butter, oily fish, liver)
Yes     No

9.Did you have weight-loss surgeries (bariatric surgery ) such as gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch, or do you suffer from digestive diseases with chronic malabsorption?
Yes     No

10. Did you take oral cortisone for more than 3 months in your life?
Never     Once     More than once

11. Did you fall without cause or did you have non-traumatic fractures?
No     Once     More than once