All Interested in the Fall 2016 Yoga vs. Osteoporosis Study Should Fill-out the Following:
In order to participate in the Yoga vs. Osteoporosis study headed by Dr. Loren Fishman, we require that you purchase the DVD for $25 on sciatica.org, and complete the following studies. They can be obtained when your physician next draws blood and takes urine. If you need a separate prescription to direct an independent lab such as Quest or Athena to conduct the proper tests, please email or fax us. Otherwise, just give this paper to your physician, and fax or email the results to:
Ms. Tina Paul
Attn: Yoga Vs. Osteoporosis
Fax: (212) 472-4127.
Necessary Lab tests (done within 6 months of study entry)
TSH (Thyroid stimulating hormone)
PTH (Parathyroid hormone)
ESR (Erythrocyte sedimentation rate)
SMA – 18 (standard electrolyte, liver and kidney function tests)
Vitamin D 25 – OH
Vitamin D 1,25 – Dihydroxy
Urine NTX (a measure of reabsorbed collagen cross-linkages)
Each applicant must also supply a current DEXA scan done within 6 months of application, and a second DEXA performed at least one year in the past.
When we have received the entry information form, the laboratory reports, your bone mineral density test or DEXA scan, and recent hip and lumbar spine X-rays, you will be inducted into the study and we will mail you a DVD. Please allow one week for processing.
If there are questions, please email Loren@sciatica.org
Yoga vs. Osteoporosis Entry Information
Email Address: ___________________________
Date of Birth F M Weight
Height Greatest Height
- Hysterectomy? Yes No First monthly period___/___ Last monthly period___/____
- Orchiectomy? Yes No
- Do you take Calcium? Y N *Daily Dose Brand/Type Date started
- Do you take Vitamin D? Y N *Daily Dose Brand/Type Date started
- Do you take Magnesium? Y N *Daily Dose Brand/Type Date started
- Other medicine for osteoporosis? Y N *Daily Dose Brand/Type Date started
- Previous medicines for osteoporosis? Y N *Daily Dose Brand/Type Date started
- Names, Dosage of all other medicines/supplements/vitamins::
- Exposed to Steriods? Y N Dosage and Dates:
- Birth Control? Y N Daily Dose Brand/Type Dates taken
- Hormone Therapy? Y N Daily Dose Brand/Type Dates taken
- Unusual Nutrition: (e.g., vegan for 20 years)
- History of Bone Fractures?
- a. Years of Yoga__________________________________________________________________
- Type of yoga (e.g., Vinyasa, Iyengar) ______________________________________________
- How often and how long? (e.g., 1 x per week, 30 min) ______________________________
How consistent? (e.g., never miss, miss every few weeks, skip weeks at a time, etc)
- a. Other Exercise (what Type, eg, Swimming) ___________________________________
- How often? (eg, 1 x per week) __ ______
- How long per session?______________________________________________________
- How consistent? ______
- a. Last DEXA scan_______________________
- Last Hip/Lumbar X-rays________________
- Family History (Please mention an family History of Osteoporosis): __________________________________________________________________________________________________
- Medical Conditions, including hip and spine surgeries: __________________________________________________________________________________________________
Please scan the results into an email and send them to Tina Paul, MS at email@example.com.
If the results of any of the blood or urine studies is abnormal, we will direct you to the proper type of physician to help bring your values in line. Once that has occurred, you will be admitted to the study.