Osteoporosis/Osteomalacia

Availability

North South North West Statewide

Pre-referral work-up

History

Referral is recommended for complicated or atypical presentations or when resistant to initial treatment.

All referrals should comply to referral standards and include in particular:

  • Family history of maternal hip fracture
  • Age at menopause
  • Known fractures
  • Dietary calcium intake
  • Steroid therapy
  • Significant past history e.g. Eating disorders, prolonged immobility, radiotherapy, chronic inflammatory diseases, poor absorption e.g. coeliac disease
  • Loss of stature
  • Current medication list
  • Relevant previous medications
  • Vertebral deformity

Tests

  • DEXA
  • Thoracic & lumbar XR if clinically indicated
  • Vitamin D
  • Calcium, PO4
  • LFT
  • U+E
  • ESR
  • FBE
  • TSH
  • Androgens in males
  • Consider coeliac screen if low BMI or iron deficiency

Interim/GP management

To refer a patient with this condition, please see the Rheumatology clinic page for the full referral process and templates.

  • Refer to guidelines from Osteoporosis Australia
  • Direct referral for Zolendronic Acid infusion is available under strict criteria for more information and referral please see  template and guidelines
  • Instructions for patient (printable version):
    • Patient will receive notification of the appointment from the hospital
    • Patient to fill the prescription for Zoledronic Acid at community pharmacy and take it will them to the appointment at the hospital
    • Patient not take NSAIDs on day of appointment
    • Patient to withhold diuretics on day of appointment if safe to do so
    • Patient to drink two glasses of water prior to appointment
    • Continue to maintain calcium and vitamin D levels by diet and/or supplements
    • Use paracetamol for post infusion discomfort

For more information please see the Tasmanian Health Pathways website.

Urgent / category 1

Acute vertebral fracture and unable to mobilise

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Patient information advice is found at Arthritis Australia

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

Please discuss with registrar or consultant. We will endeavour to see these patients within four weeks.

Urgent referrals (e.g. temporal arteritis, septic arthritis) should be accompanied by a phone call to the Rheumatology Registrar or Consultant for urgent assessment, or patient should be directed to the Emergency Department.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment