Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • pathological fractures with a suspicion of underlying malignancy
  • fracture with hypercalcaemia (serum calcium greater than 2.80 mmol/l)

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network


  • age-appropriate osteopenia without fracture/s
  • clinically stable hypothyroidism
  • metabolic bone disease when the person’s life expectancy is less than 6 months
  • osteopaenia without fracture or complications
  • osteoporosis on bone mineral density (BMD) without fracture
  • osteoporosis without first-line management
  • postmenopausal osteoporosis where:
    • treatment has not been initiated and no explanation for not initiating treatment has been provided, or
    • treatment has been initiated, but treatment response has not been assessed with repeat bone density and there is no other concern raised
  • renal bone disease – refer to nephrology

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • BMD z-score less than -2.0
  • progressive deformity
  • recurrent/current fracture/s despite first-line management
  • severe bone pain

Category 2 — appointment clinically indicated within 90 days

  • fibrous dysplasia
  • long term glucocorticoids with BMD T-score less than -1.5
  • in individuals in where contraindications/concerns regarding conventional treatment exists
  • low trauma fracture where contraindications/concerns regarding conventional treatment exists
  • osteomalacia
  • osteoporosis where pharmaceutical benefits scheme (PBS) thresholds are not met e.g. inflammatory bowel disease
  • Paget’s disease
  • post-transplant osteoporosis (BMD T-score less than -2.5)
    • and/or fracturing and/or using glucocorticoids

Category 3 — appointment clinically indicated within 365 days

  • other (suspected) metabolic bone disease e.g. osteogenesis imperfecta

For more on outpatient referrals, see the general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical history, including fractures, alcohol history, diarrhoea and iron deficiency
  • family history
  • current medications and dosages, including supplements, glucocorticoid therapy, previous and current anti-resorptive therapies
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • physical examination:
    • menopausal status including early menopause
    • male hypogonadism
  • height/weight
  • body mass index (BMI)
  • Malnutrition Universal Screening Tool (MUST) score
  • bone mineral density (BMD) scan including z-score
  • relevant plain X-rays (lateral X-ray thoracic and lumbar spine)


  • complete blood examination (CBE)
  • urea, electrolyte, and creatinine (UEC)
  • liver function test (LFT)
  • erythrocyte sedimentation rate (ESR)
  • plasma calcium (total and corrected)
  • alkaline Phosphatase (ALP)
  • thyroid function test (TFT)
  • serum parathyroid hormone (PTH)
  • vitamin D 25-OH
  • serum testosterone 8.00 to 9.00 am
  • luteinizing hormone (LH)
  • follicle-stimulating hormone (FSH), males
  • fasting serum CrossLaps
  • coeliac screen
  • plasma electrophoresis

Clinical management advice

Conditions encompass idiopathic osteoporosis, corticosteroid-induced bone disease, osteomalacia, Paget's disease, osteogenesis imperfecta, along with other metabolic bone disorders. Please refer any cases of renal bone disease to nephrology specialists for appropriate management.

Uncomplicated postmenopausal osteoporosis with fracture should be able to be managed in primary care.

First-line management for osteoporosis includes:

  • enhancing calcium and vitamin D levels for optimal bone health
  • engaging in weight-bearing exercises to promote bone strength
  • considering oestrogen or testosterone supplementation in cases of hypogonadism
  • utilising fracture risk calculators to aid in determining the necessity for specific pharmacological interventions; typically reserved for instances with a high 10-year fracture risk (greater than 3% for hip fracture, and greater than 20% for any fracture).

If bone mineral density (BMD) Z-score is less than -2.0 it is advisable to investigate potential secondary causes of osteoporosis.

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Clinical resources

Consumer resources