Referral to a medical specialist

Evidence statement

Even though most experts agree that referral to specialists (eg endocrinologist, rheumatologist) is important for specific conditions, there is no clear agreement as to what these conditions are. Circumstances depend on a combination of factors including severity of the condition, response to available treatment, availability of resources and general practitioner (GP) expertise and support. There is strong consensus that in specific situations GPs should refer patients to a specialist or a specialist bone centre. The following are strong indicators for referral in postmenopausal women and men over 50 years of age:^1,2

• Osteoporosis is unexpectedly severe or has unusual features at the time of initial assessment
• Intolerance of first and second-line therapies, or experiencing problems beyond the scope of general practice
• Fracture or significant ongoing loss of BMD while on first-line therapy, despite good adherence
• Secondary causes that are outside the scope of general practice