Criteria for referral to public hospital specialist clinic services
- Suspected metabolic bone disease that is not osteoporosis (for example: Paget’s disease, fibrous dysplasia, osteomalacia, osteogenesis imperfecta)
- Persistent osteoporosis despite 3 years of maximum antiresorptive treatment
- Intolerance to, or contraindication for, maximum antiresorptive treatment
- Metabolic bone disease associated with:
- treatment with glucocorticoid medicines
- chronic kidney disease
- Osteoporosis in women < 50 years or men < 60 years
- Secondary osteoporosis due any of the following:
- primary hyperparathyroidism
- male hypogonadism
- amenorrhea in women < 40 years.
- Advice on, or review of, management plan in patients with stable metabolic bone disease after 5 years of treatment.
Information to be included in the referral
Information that must be provided
- Details of all fractures, including location
- Details of previous medical management including the course of treatment and outcome of treatment
- Current and complete medication history (including non-prescription medicines, herbs and supplements)
- Recent (preferably in last 3 months):
- serum calcium result
- serum 25-hydroxy vitamin D (25(OH)D)
- phosphate blood test result
- creatinine and electrolytes result
- albumin blood test result
- alkaline phosphate (ALP) blood test result.
- Relevant comorbidities.
Provide if available
- Current or previous bone densitometry results
- Current or previous radiological reports of any fractures
- Parathyroid (PTH) blood test result.
The Summary and referral information lists the information that should be included in a referral request.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Osteoporosis that has not been treated
- Age appropriate osteopenia without fracture(s)
- When the person’s life expectancy is < 6 months.