When should I consider referring a patient with osteomalacia to a specialist for further evaluation?

Consider referring a patient with osteomalacia to a specialist for further evaluation if:

• There is uncertainty regarding diagnosis or management, especially if the patient has clinical features such as bone pain, muscle pain, or proximal muscle weakness suggestive of osteomalacia.
• The patient has vitamin D deficiency that is not responding to standard treatment or requires high-dose vitamin D therapy, as specialist advice is recommended for appropriate dosing and monitoring.
• There is a suspicion of underlying causes that require specialist input, such as malabsorption syndromes, chronic kidney disease, or other metabolic bone disorders.
• The patient has complications or atypical presentations that need further investigation beyond primary care capabilities.

Referral ensures appropriate specialist assessment, tailored treatment plans, and monitoring to prevent complications associated with osteomalacia.

These recommendations align with guidance to seek specialist advice when there is uncertainty about calcium or vitamin D supplementation, or when managing complex cases of vitamin D deficiency and osteomalacia.

References: NICE CKS, NICE CKS