Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age

Recommendations

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

Grade: D – consensus

Recommendation 7
Refer postmenopausal women and men over 50 years of age to a specialist or a specialist bone centre according to individual need, or when there is restricted access to appropriate resources or required expertise.

The following conditions might require a referral to a specialist or a specialist bone centre, depending on individual circumstances:

  • Lack of access to appropriate bone densitometry service
  • Osteoporosis is unexpectedly severe or has unusual features at the time of initial assessment
  • Inadequate response to therapy, despite good adherence
  • Contraindications to standard therapies
  • Presence of other complex medical conditions
  • Experiencing serious or unacceptable adverse effects with treatment
  • Continuing to fracture despite normal bone mineral density (BMD)
  • Secondary cause is identified or suspected (eg Z-score ≤–2.0)

Related documents

  Osteoporosis-flowchart.pdf (PDF 0.98 MB)