Which patients on corticosteroids should be referred for specialist assessment regarding osteoporosis management?

Patients receiving corticosteroid therapy who should be referred for specialist assessment regarding osteoporosis management include those with a high fracture risk or evidence of bone loss. This includes patients on current or frequent recent use of oral or systemic glucocorticoids, especially if they have additional risk factors such as previous fragility fractures, low body mass index, or other causes of secondary osteoporosis.

Referral is particularly indicated if fracture risk assessment tools (such as FRAX or QFracture) indicate a high 10-year predicted fracture risk, or if a dual-energy X-ray absorptiometry (DXA) scan shows positive results for osteoporosis.

In children and young people treated with systemic corticosteroids, monitoring bone health is recommended, and referral to specialists should be considered if there are concerns about growth, pubertal development, or bone health.