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 |