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Osteoporosis and Metabolic Bone Disease Rheumatology Referral Access Criteria

Osteoporosis and Metabolic Bone Disease Rheumatology Referral Access Criteria

Referrers should use this page when referring patients to public adult rheumatology outpatient services for Osteoporosis and Metabolic Bone Disease.
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.
  • Nil
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate rheumatology assessment (seen within 7 days):
  • Nil

To contact the relevant service, see HealthPathways: Acute Rheumatology Assessment (external site).
Presenting issues
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Suspected metabolic bone disease that is not osteoporosis (for example: Paget’s disease, fibrous dysplasia, osteomalacia, osteogenesis imperfecta)
  • Osteoporosis in women <50 years or men <60 years
  • Persistent osteoporosis despite maximum treatment
  • Intolerance to, or contraindication for, maximum antiresorptive treatment
  • Metabolic bone disease associated with:
    • Treatment with glucocorticoid medicines
    • CKD
    • Post-transplant
    • Inflammatory disorders
  • 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
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
  • Details of all fractures, including location
  • Current medication list
  • Any known allergies
  • Details of previous treatment and outcome
  • Relevant comorbidities
Examination
  • Nil
Investigations
  • Recent (within last 3 months):
    • Ca
    • 25(OH) Vit D
    • PO4
    • U&Es
    • ALB
    • ALP
  • Current or previous bone densitometry results
  • Current or previous radiological reports of any fractures
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • PTH
  • Fasting metabolic bone studies serum and urine
  • Cancer screening if applicable
Indicative triage category

Category 1

Appointment within 30 days

  • Recurrent or current fractures despite initiation of treatment for osteoporosis

Category 2

Appointment within 90 days

  • Paget’s disease
  • Fibrous dysplasia
  • Osteomalacia
  • Low trauma fracture, in individuals in whom there are contraindications/concerns regarding conventional osteoporosis management
  • 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 for e.g. inflammatory bowel disease
  • Unexplained osteoporosis

Category 3

Appointment within 365 days

  • Other (suspected) metabolic bone disease e.g. osteogenesis imperfecta
Exclusions
  • Osteopenia without fracture(s)
  • Routine uncomplicated osteoporosis
  • Metabolic bone disease where a person’s life expectancy is <6 months
  • Secondary hyperparathyroidism due to vitamin D deficiency, CKD, or use of bisphosphonate
Useful information

Clinical resources
Last reviewed: 18-03-2024
wa.gov.au