When to Consult with a Bone Expert

  • Thank goodness for a primary care provider, the "jack of all trades". However, sometimes the "jack of all trades" is the master of nothing and may not offer the best solutions for osteoporosis treatment. Seeing a specialist can offer advantages of the latest research and newest treatment options. In certain circumstances, treating osteoporosis can be much more complicated than seeing a number on a bone density test and writing a prescription. As a person concerned about your bone health, you need to know when to see a bone specialist. You need to know who to see and where to find the experts in the field of bone health.

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    In most circumstances, the primary care provider is perfectly capable of treating osteopenia and osteoporosis. These cases may be uncomplicated by other risk factors, not of a severe nature, and responsive to traditional methods of care. But time to time, some mitigating circumstances arise that would require a specialists care. Six such circumstances are:


    1. Frequent Fragile Fractures: Multiple fragile fractures under normal bone density or low normal bone density circumstances are not normal. A specialist should be consulted especially if the fractures are ongoing despite treatment of with a bone stabilizing medication.

    2. Young Age for Osteoporosis: Women who are pre-menopausal or under the age of 40 who have osteoporosis should consult with a bone specialist to help rule out conditions like Osteogenesis Imperfecta and Idiopathic Juvenile Osteoporosis. Men under the age of 60 with osteoporosis should also see a specialist.

    3. Unresponsive to Treatment: Once placed on a bone stabilizing medications, the bone density should improve and certainly not worsen. After starting on a medication, the bone density should be checked periodically in order to make sure the bone density is improving and not getting worse.

    4. Severe Osteoporosis: If the T score is less than -3.0, the likeliness of a metabolic bone disease or secondary cause of osteoporosis increases. Primary care providers are usually not that thorough about looking for other reasons to have poor bone density; thus, a specialist in bone health should be seen.

    5. High Risk: Those who are at high risk for osteoporosis are those who have secondary reasons to have osteoporosis. For example, those who have hormonal imbalances like diabetes, hypothyroidism or hypogonadism should pay close attention to bone health and consider seeing a specialist. Additionally, anyone who frequently uses steroids like those with irritable bowel syndrome, rheumatoid arthritis, sickle cell disease or an organ transplant should consult with a bone specialist.

    6. Unable to Tolerate Treatment: Medications used to treat osteoporosis can cause intolerable side-effects and adverse reactions. A bone specialist can help find alternative solutions.


    If you fall into any of these six categories of complicated osteoporosis, you should consult with a specialist about your bones. Who should you see? Probably the most overlooked specialist to consider is an Endocrinologist who focuses on Bone Mineral Health. These highly specialized endocrinologists can pinpoint a potential metabolic disease like Paget's disease. Other specialists are also worth considering depending on accessibility. A physiatrist, an orthopedist, a rheumatologist and a woman's health specialist all have valuable knowledge about the bone system. And knowledge is important when dealing with any medical condition.


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    Where can you find the most knowledgeable bone specialist? Several major medical hospitals/systems offer bone programs. For example, there is the bone program associated with Washington University in St. Loius. The Henry Ford medical system in Michigan has a bone program. Search and you will find special bone programs that can help you with a special bone problem. In fact, there is a society of professionals for Bone Mineral Research which may be able to help you find a member nearby. If you need to see a specialist, talk to your primary care provider and take action.

Published On: October 20, 2010