I’m looking for advice on which type of specialist is most appropriate for my situation — a rheumatologist, an endocrinologist, or a consultant from a dedicated metabolic bone unit.
My DEXA results are:
Spine T‑score: −3.1
Hip T‑score: −2.6
I’m small‑framed and considered high fracture risk.
Because of ongoing dental issues and the likelihood of future extractions, I’m trying to explore non‑bisphosphonate treatment pathways. I know that Oxford has an NHS Metabolic Bone Unit, and I’m also considering arranging a private consultation to get a clear treatment plan.
For those with similar experiences:
Which type of consultant would be best to see ?
And has anyone had experience with private consultation at the metabolic bone unit in NHS Oxford? I don’t mind travelling there.
It’s difficult to tell, in my hospital osteoporosis appears to be treated in the rheumatology dept but I imagine it could depend on what caused the osteoporosis - if your osteoporosis was caused by say, hyperparathyroidism - I imagine that would show up in your blood tests - the parathyroid gland is not the same as the thyroid gland then it is possible it might be treated by an endocrinologist but I’m not a doctor so that is only a guess.
Have a look at this page and you will see that there are lots of factors that can contribute to osteoporosis so treatment could depend on whatever conditions caused the osteoporosis in the first place.
Causes of osteoporosis .._gsMQ..&gclid=EAIaIQobChMIlae69trAkwMVtZtQBh1W-irbEAAYAiAAEgLuePD_BwE&gbraid=0AAAAApWHy-vma0KlfKgZBmGC1TzKdFXwj
It might be worth talking to someone at the metabolic bone unit to explain about your circumstances and to find out what type of conditions the the metabolic bone unit treats before you commit yourself.
Have you thought of calling the ROS helpline - I’m sure s9me9ne there will be able to explain the reasoning behind who would be best to treat you : Free osteoporosis Helpline
I’m under a rheumatologist as I have PMR and am on Prednisolone. Had a DEXA scan after being on the steroids for 3 and 1/2 months and diagnosed with osteoporosis in my spine, hips are borderline. I can’t see that the steroids affected my bone density so fast but like you I am small framed ( 5’1) and have always had a BMI of around 19 to 20. Also early menopause, been on HRT now for 10 years and my bloods I had done back in August at the start of my PMR showed subclinical hyperthyroidism which potentially could have been there for some time. So I’m stuffed all round really. Have another thyroid test next month and if levels are the same I may be referred to endocrinologist. Be interesting to see what they have to say over and above Rheumatology.
Hi Peach Mango I have similar T scores to you, with no hyperthyroidism etc issues and was referred via the local Fracture Liaison Service to a rheumatologist at the Oxford Bone Clinic where I was prescribed romosozumab. So I would think a rheumatologist would be a good starting point
Because it was through the Fracture Liaison Service (I had had a fragility fracture) I was referred for a dexa scan and then after 2 months spoke on the phone to a nurse working in the rheumatology team who then arranged for me to go onto romosozumab. So I never spoke to the rheumatologist, just the nurse.
I know at the clinic they are keen to get patients onto anabolic
s if they meet the criteria because they are shown to have such good outcomes. However, romosozumab has the same issues for dental problems as bisphosphonates, which may be an issue for you.
Thank you so much to those who’ve already shared in this thoughtful conversation. We just wanted to pop in with a few links that might be helpful if anyone would like to explore some of the topics mentioned here a little more
What type of specialist do I see for osteoporosis?
I’m under the care of Professor Kassim Javaid at the Metabolic Bone and Osteoporosis Clinic at the Nuffield Orthopaedic Hospital in Oxford. Can’t speak highly enough about the care he has given me over the past 9 years since the first of several spinal fractures. Unfortunately, at times it can be the NICE guidelines that prevent him from getting patients on to particular medication. That said he will ‘fight’ your corner if need be. My osteoporosis is hereditary, I’m one of six children and 3 of us have osteoporosis, sister and one of my brothers. My sister’s T scores are much worse than mine yet she has not had any fractures we lead a very similar lifestyle. I think there needs to be more information on not just bone density but bone strength. Hopefully, you’ll get an appointment with the Professor or one of his colleagues. I don’t post often on this forum because unless you’ve had spinal fractures that led to a loss of 5 inches in height which in turn led me to have severe kyphosis. I am always going to have to deal with on going pain and only people with similar issues will understand. Sadly, since the pandemic we very much have to be proactive in getting the care we need. My advice would be to push for what you decide on. I have been able to tap into the many things that are available to you at the NOC. Physiotherapists, hydrotherapy, Optimise course but you have to be your own advocate-those that shout the loudest etc. I hope you get the treatment you deserve. Don’t be afraid to push for what you need, or who to see. I wish you all the best. Onwards and upwards
