Bone Health and Bone Mineral Metabolism Referral Access Criteria
Bone Health and Bone Mineral Metabolism Referral Access Criteria
Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for bone health and bone mineral metabolism. This RAC is applicable to referrals for patients aged <16 years only. |
Emergency referral |
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- Symptomatic hypocalcaemia with low calcium levels (usually serum calcium <2.0mmol/L) and/or cardiac arrythmias
- Symptomatic hypercalcaemia with elevated calcium levels (usually serum calcium >3.0mmol/L) and/or cardiac arrythmias
- Neonatal calcium disorders
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Immediate referral |
Immediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
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To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)
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Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS). |
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Mandatory information |
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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History |
- Relevant history, onset, duration and severity of symptoms
- Current medication list
- Any known allergies
- Familial history of bone and mineral disorders and fractures
- Relevant medication use on bone and mineral metabolism
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Examination |
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Investigations |
- Ionised calcium and/or serum total and corrected calcium
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Highly desirable |
History |
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Examination |
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Investigations |
- Phosphate
- Magnesium
- Alkaline phosphatase
- Vitamin D 25 OH
- PTH
- XR of fracture/bone deformities (if present)/skeletal survey if indicated
- Bone mineral density for referral for bone fragility disorders
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Indicative clinical urgency category |
Category 1
Appointment within 30 days
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- Follow up clinic from emergency presentation
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Category 2
Appointment within 90 days
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- Alterations of bone and mineral metabolism
- Suspected bone fragility disorder (recurrent fractures, vertebral fractures)
- Rickets
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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Exclusions |
- Mild forms of vitamin D deficiency
- Skeletal dysplasia
- If affecting CSH drainage, refer to neurosurgery
- If affecting limb function, refer to orthopaedics
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Useful information |
- See Australia and New Zealand Society for Endocrinology and diabetes for clinical resources (external site)
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Feedback
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Last reviewed: 18-03-2024