When should I consider referring a patient for specialist assessment in cases of osteoporosis?

Consider referring a patient for specialist assessment in osteoporosis if they are at very high risk of fragility fracture. This includes people with:

• a recent vertebral fracture within the last 2 years,
• two or more vertebral fractures regardless of timing,
• a bone mineral density (BMD) T-score of -3.5 or lower,
• taking high-dose glucocorticoids (7.5 mg or more prednisolone daily or equivalent for over 3 months),
• multiple clinical risk factors, especially with a recent fragility fracture indicating high imminent risk of re-fracture,
• other indicators of very high fracture risk.

Additionally, refer younger patients (<40 years) with major risk factors such as high-dose corticosteroid use or previous major osteoporotic fractures to a specialist experienced in osteoporosis treatment.

Also consider specialist referral for patients with secondary causes of osteoporosis or complex underlying conditions contributing to bone fragility.