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Diabetes and Endocrinology · Refer Your Patient
Osteoporosis and metabolic bone disease
Copied from the official Gold Coast Health condition page (27 Aug 2026). Hospital triage assigns the official category. Live source: Refer Your Patient — Osteoporosis and metabolic bone disease.
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Cat 1 · 30 days
appointment within 30 calendar days. - Fracture with delayed or missed denosumab therapy
- Consideration for osteoanabolic therapy (as first-line treatment) in a very high-risk patient with Bone Mineral Density (BMD) T-score < -2.5 and any of the following:
- > 1 hip or symptomatic vertebral fracture in the previous 24 months
- > 2 fractures, including 1 symptomatic new fracture in the previous 24 months
NB please do not start these patients on anti-resorptive therapy while waiting for review
- T-score ≤ -3 and recurrent fractures despite adequate anti-resorptive therapy for at least 12 months, for consideration of second-line osteoanabolic therapy
- Osteonecrosis of the jaw on anti-resorptive treatment for consideration of modifying ongoing osteoporosis therapy
Cat 2 · 90 days
appointment within 90 calendar days. - Recurrent or current fractures despite initiation of treatment for osteoporosis
- Paget’s disease – symptomatic or ALP ≥2 fold ULN
- Fibrous dysplasia
- Osteomalacia
- Low trauma fracture, in individuals in whom there are contraindications/concerns regarding conventional osteoporosis management
- Atypical femoral fracture
- 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 (e.g. Inflammatory bowel disease)
- Unexplained osteoporosis
- Complex treatment considerations in osteoporosis, such as, but not limited to:
- Aged < 30 years,
- Estimated glomerular filtration rate (eGFR) < 30 mL/min/m2,
- Minimal trauma fracture in pre-menopausal women
Cat 3 · 365 days
appointment within 365 calendar days. - Osteoporosis on BMD without fracture in patients <70 years
- Other (suspected) metabolic bone disease e.g. Osteogenesis imperfecta
- Incidental finding of localised Paget’s disease changes on bone scan with ALP < 2 fold ULN
Essential referral information
Referral will be returned without this. If a mandatory test cannot be obtained, say so in the referral.
History including
- menopausal status
- alcohol/smoking history
- fractures & medications
- glucocorticoid therapy
- hypogonadism
- weight loss
- diarrhoea and iron deficiency
- Details of all treatments offered and efficacy
- FBC ELFT ESR vitamin D TSH, EPP, FLC, urine BJP, anti-tissue transglutaminase antibodies, IgA
- Bone mineral density and XR reports of fracture if relevant
- For men, please include tests for hypogonadism (morning testosterone, LH, FSH and SHBG)
Out of scope / wrong door
The following conditions are out of scope for this service:
- Pre-diabetes
- Stable, well-controlled type 2 diabetes
- Newly diagnosed type 2 diabetes and not acutely unwell
- Referrals where the primary problem requiring attention is not directly related to the diabetes and should be directed to another speciality service e.g. chest pain for investigation should go to cardiology
- Dietary advice for weight reduction, high cholesterol, hypertension or CVD in patients with diabetes
- Newly diagnosed primary hypothyroidism, including subclinical hypothyroidism – Note: in women of child bearing age who are pregnant or wishing to become pregnant or not using contraception, thyroxine should be commenced and titrated, aiming for a TSH less than 2.5
- Positive thyroid antibodies with normal thyroid function
- Osteopaenia
- Routine uncomplicated osteoporosis
Parent service: Diabetes and Endocrinology
Send outpatient referrals to
- Smart Referrals preferred (Best Practice or Medical Director)
- Medical Objects GQ42150009Z (lookup qh → QHEALTH, GOLD COAST HEALTH OUTPATIENT)
- HealthLink EDI Qldgchsd
- Fax (07) 5687 4497 — Booking and Referral Centre
- Post: Booking and Referral Centre, Gold Coast University Hospital, 1 Hospital Boulevard, Southport QLD 4215
- Clinic enquiries 1300 559 083
How to refer — full order
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