Medical Bone Service
Speciality Description
- The Medical Bone Service predominantly sees patients with osteoporosis in addition to patients with other metabolic bone disease such as Paget’s disease of bone, osteogenesis imperfecta, fibrous dysplasia.
- Our team consists of three doctors and a nurse specialist. We provide in-person and telephone out patient appointments across NHS Tayside. Currently there are 5 Medical Bone clinics and 8 Specialist Nurse clinics each month.
- Our Specialist Nurse co-ordinates NHS Tayside’s Fracture Liaison Service which is a system of care recommended by SIGN 142 for patients, mainly over the age of 50, who have experienced a low trauma fracture. These patients are identified retrospectively and after a virtual clinical assessment are invited via letter to opt in if they wish a DXA scan. This system of care complements the DXA referrals for patients with a new low trauma fracture received via GP referrals, orthopaedic services and medicine for the elderly.
- Our team also provides a reporting service for DXA scanning. Most of these reports will be issued with management advice. Patients with newly identified atypical bone density are referred directly to the Medical Bone clinic at the time of reporting.
- The DXA service sits within, and is managed by, the Radiology department. DXA scanners are located at Perth Royal Infirmary and Kings Cross Hospital, Dundee. All requests for DXA scans should be made on ICE.
Who to Refer
- Patients < 75 years with osteoporosis who are intolerant of oral bisphosphonate therapy. Patients over 75 years should be referred to the locality MfE team for assessment.
- Patients with osteoporosis who have sustained a new vertebral fracture despite appropriate adherence to oral bisphosphonate therapy.
- Patients with DXA proven osteoporosis for consideration of either teriparatide or romosozumab who satisfy criteria for anabolic therapy as detailed on Tayside Adult Formulary.
- Patients with other metabolic bone disease e.g. Paget’s disease of bone, osteogenesis imperfecta, osteomalacia, osteopetrosis, fibrous dysplasia.
Who not to Refer
- Primary hyperparathyroidism - please refer to Endocrinology
- Intolerance to oral bisphosphonate > 75 years – please refer to MfE
- Intolerance to oral bisphosphonate, initiated by Clinical Oncology in association with aromatase inhibitor therapy – please refer back to Clinical Oncology
- All DXA scan requests should be made on ICE
How to Refer
- Clinic referral – via SCI-Gateway/ Medical Bone Clinic
- Advice request – via SCI Gateway/ Medical Bone Clinic (in preference to paper communication)
- All DXA referrals should be made via ICE
Useful Resources