| Group |
| Date of Enrollment |
|
| Name |
| Medical Record No. |
|
| Sex |
| Age |
|
| Weight |
| Tel |
|
| Underlying Disease(s) |
| ||
| Medication History |
| ||
| Lumbar spine BMD |
| Hip BMD |
|
| VAS upon Enrollment |
| β-cross upon Enrollment |
|
| Ca upon Enrollment |
| Creatinine upon Enrollment |
|
| Pre-treatment Adverse Reactions |
| ||
| Pre-treatment VAS |
| Pre-treatment β-cross |
|
| Pre-treatment Ca |
| Pre-treatment Creatinine |
|
| Pre-treatment Body Temperature |
| Post-treatment Body Temperature (peak temperature) |
|
| Onset |
| Duration |
|
| Post-treatment VAS (a week after injection) |
| ||
| Post-treatment Ca (a week after injection) |
| Post-treatment Creatinine (a week after injection) |
|
| Pharmaceutical Intervention | □ Yes □ No | ||
| Adverse Reactions (e.g., palpitation, oliguria, tics) | □ Yes □ No | ||
| Fill-in Date |
| ||