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Table 10 When to Refer to an Osteoporosis Specialist [47].

From: Management of osteoporosis

Referral to an osteoporosis specialist is appropriate when the patient is in any of the following circumstances:
1. Has osteoporosis that is unexpectedly severe or has unusual features at the time of initial assessment
Has very low BMD (a T-score below -3.0 or a Z-score below -2.0)
Has osteoporosis despite young age (premenopausal)
Has fractures despite borderline or normal BMD
2. Has a suspected or known condition that may underlie the osteoporosis (for example, hyperthyroidism, hyperparathyroidism, hypercalciuria, Cushing's syndrome, or hypogonadism)
3. Is a candidate for combination therapy
4. Is intolerant of approved therapies
5. Fails to respond to treatment
Takes estrogen yet has low baseline BMD
Is undergoing treatment yet shows an apparent loss of BMD on serial studies
Has fractures on treatment
  1. Most osteoporosis patients can be successfully managed by the primary care physician, but a small percentage with unusual or difficult problems can benefit from consultation with an osteoporosis specialist. Referral to an osteoporosis specialist is appropriate when the patient is in any of the following circumstances: