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Bone Health and Bone Mineral Metabolism Referral Access Criteria

Bone Health and Bone Mineral Metabolism Referral Access Criteria

Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for bone health and bone mineral metabolism. This RAC is applicable to referrals for patients aged <16 years only.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Symptomatic hypocalcaemia with low calcium levels (usually serum calcium <2.0mmol/L) and/or cardiac arrythmias
  • Symptomatic hypercalcaemia with elevated calcium levels (usually serum calcium >3.0mmol/L) and/or cardiac arrythmias
  • Neonatal calcium disorders
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
  • Nil

To contact the relevant service, see HealthPathways: Acute Paediatric Assessment (external site)
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Recurrent fractures
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration and severity of symptoms
  • Current medication list
  • Any known allergies
  • Familial history of bone and mineral disorders and fractures
  • Relevant medication use on bone and mineral metabolism
Examination
  • Nil
Investigations
  • Ionised calcium and/or serum total and corrected calcium
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • Phosphate
  • Magnesium
  • Alkaline phosphatase
  • Vitamin D 25 OH
  • PTH
  • XR of fracture/bone deformities (if present)/skeletal survey if indicated
  • Bone mineral density for referral for bone fragility disorders
Indicative triage category

Category 1

Appointment within 30 days
  • Follow up clinic from emergency presentation

Category 2

Appointment within 90 days

  • Alterations of bone and mineral metabolism
  • Suspected bone fragility disorder (recurrent fractures, vertebral fractures)
  • Rickets

Category 3

Appointment within 365 days
  • No defined category 3 criteria
Exclusions
  • Mild forms of vitamin D deficiency
  • Skeletal dysplasia
    • If affecting CSH drainage, refer to neurosurgery
    • If affecting limb function, refer to orthopaedics
Useful information
  • See Australia and New Zealand Society for Endocrinology and diabetes for clinical resources (external site)
Last reviewed: 18-03-2024
wa.gov.au