The Osteoporosis and Metabolic Bone Disease clinics are run under the supervision of two consultants with one clinical nurse specialist.

The service offers:

• two, monitoring, nurse-led clinics, including denosumab injections
• daily infusion clinic for intravenous bisphosphonate therapy (pamidronate and zolendronic acid)
• a fracture liaison service within the hospital
• expertise in the management of many rare conditions, such as Paget disease, osteogenesis imperfecta (brittle bone disease) and provides a regional and national specialist clinical service for these patients

Eligibility Criteria

Inclusions

• osteoporosis or fragility fracture in a young patient (under 50y) 
• patients who have suffered fragility fractures or have a fracture risk above the National Osteoporosis Guideline Group (NOGG) intervention threshold, and have not tolerated oral bisphosphonates, or who have a contra-indication to oral bisphosphonates (including chronic kidney disease) 
• patients who have suffered fragility fractures on osteoporosis treatment 
• patients at very high fracture risk as defined by the NOGG threshold in FRAX 
• patients with complex disease:
  • steroid-induced osteoporosis
  • multiple previous osteoporosis treatments
  • past major complications of treatment, such as osteonecrosis of the jaw, atypical femoral fracture 
• patients suspected of having Paget's disease.

Referrals will be prioritised for the following patient groups who may require first‑line treatment with anabolic agents:

• patients with two or more vertebral fractures
• patients with a major osteoporotic fracture (vertebral, neck of femur, distal radius, pelvis, or humerus) within the past two years and one or more of the following:
  • T‑score < -3.5
  • very high fracture risk, as defined by the NOGG intervention threshold
  • current steroid use equivalent to 7.5 mg/day of prednisolone for three months or more

How to Refer