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 maximum treatment
• Osteoporosis in women < 50 years or men < 60 years
• Intolerance to, or contraindication for, maximum treatment
• Metabolic bone disease associated with:
  • treatment with glucocorticoid medicines
  • inflammatory disorders
  • chronic kidney disease
  • post-transplant
• Metabolic bone disease associated with complications associated with treatment:
  • atypical femoral fracture
  • osteonecrosis of the jaw
• 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 (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.

Referrals to a rheumatology service are most appropriate for: 

• Metabolic bone disease associated with:
  • treatment with glucocorticoid medicines
  • inflammatory disorders
• Metabolic bone disease associated with complications of treatment:
  • atypical femoral fracture
  • osteonecrosis of the jaw.

Other referrals are likely to be directed to an alternative specialist clinic or service.

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.