When should a gynecologist refer a patient for specialty care in osteoporosis?

The field of obsteterics and gynecology occupies a unique position among those who care for patients with osteoporosis. As a generalist or primary care giver, the gynecologist is often the first physician to detect low bone mass or osteoporosis in an aging woman. As a specialist, the gynecologist may also have inner knowledge about this disease and is equipped to handle both the straightforward and the most challenging individuals with osteoporosis. Therefore, in some instances, the gynecologist will rarely refer patients to a specialist; other times, a gynecologist will consider referral to a specialist to be routine and often indicated. In this article, I suggest six reasons why someone in obstetrics and gynecology might refer a patient to a specialist in osteoporosis. These points include the discovery of low bone mass in a premenopausal woman; possible etiologies besides aging and the menopause, the occurrence of a fragility fracture in a woman whose T-score is not in the osteoporotic range; lack of access to instruments that measure central (spine and hip) bone density; challenging therapeutic settings; and the patient who is not improving on FDA-approved therapy.