Osteoporosis and metabolic bone disease

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • No emergency indicators identified; routine prioritisation applies
    • Refer to local HealthPathways or local guidelines
    • Optimize calcium intake (1000-1300mg/d) and vitamin D status (target >50nmol/L)
    • Address smoking minimisation/Quitting
    • Encourage healthy guidelines for alcohol intake (≤2 standard drinks per day and < 10 standard drinks/week)
    • Weight-bearing exercise – specifically resistance exercise or the ONERO program if accessible
    • Consider health plan for access to physio/exercise physiologist Allied health referrals for chronic disease health care plans - Health professionals - Services Australia
    • Denosumab should not be prescribed as first line therapy for patients less than 70 years, unless life expectancy <10 years
    • Use a fracture risk calculator (FRAX or Garvan) to help guide the need for specific drug therapy, usually considered if high 10-year risk of fracture (Hip fracture >3%, major osteoporotic fracture > 20%)
    • Uncomplicated postmenopausal osteoporosis with fracture should be able to be managed in primary care


    Clinical Resources

    • Calcium and bone health-position statement for ANZBMS, Healthy Bones Australia and ESA
    • Healthy Bones Australia / RACGP guidelines
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Recurrent or current fractures despite initiation of treatment for osteoporosis
  • Fracture with delayed or missed denosumab therapy
Category 2
(appointment within 90 calendar days)
  • New diagnosis severe osteoporosis with T ≤3.0 and recent fracture
  • Paget’s disease – symptomatic or ALP ≥2 fold ULN
  • Fibrous dysplasia
  • Osteomalacia
  • Low trauma fracture, in individuals in whom there are contraindications/concerns regarding conventional osteoporosis management
  • Atypical femoral fracture
  • Long term glucocorticoids with BMD t-score <-1.5, in individuals in whom there are contraindications/concerns regarding conventional osteoporosis management
  • Post-transplant osteoporosis (BMD t-score <-2.5) and/or fracturing and/or using glucocorticoids
  • Osteoporosis where PBS thresholds are not met (e.g. Inflammatory bowel disease)
  • Unexplained osteoporosis
Category 3
(appointment within 365 calendar days)
  • Osteoporosis on BMD without fracture in patients <70 years
  • Other (suspected) metabolic bone disease e.g. Osteogenesis imperfecta
  • Incidental finding of localised Paget’s disease changes on bone scan with ALP < 2 fold ULN

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History including
    • menopausal status
    • alcohol/smoking history
    • fractures & medications
    • glucocorticoid therapy
    • hypogonadism
    • weight loss
    • diarrhoea and iron deficiency
  • Details of all treatments offered and efficacy
  • FBC ELFT ESR vitamin D TSH, EPP, FLC, urine BJP,  anti-tissue transglutaminase antibodies, IgA
  • Bone mineral density and XR reports of fracture if relevant
  • For men, please include tests for hypogonadism (morning testosterone, LH, FSH and SHBG)

3. Additional referral information Useful for processing the referral

  • Lateral XR thoracic and lumbar spine reports

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

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