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
    • post-transplant.
  • Osteoporosis in women < 50 years or men < 60 years
  • Secondary osteoporosis due any of the following:
    • hyperthyroidism
    • 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.

Additional comments

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.