Shaping better health
REMEDY : BNSSG referral pathways

Advice and Guidance

Checked: 16-11-2018 by vicky.ryan Next Review: 29-10-2019

Advice and Guidance

Rheumatology Advice and Guidance services are now provided by consultants at UHB and WGH to request advice on patient's aged 16 years and over.

Please see the Rheumatology A&G Steps - UHB (word doc) for further guidance on how to submit a request through e-Referral.


UHB are now providing advice and guidance services for adult patients suffering from Osteoporosis. This service should be utilised where advice is required on the management of a patient that may avoid the need for referral. It should not be used where immediate advice is required, in which case the on call teams should be contacted in the usual way.

Requests for advice and guidance should be submitted vie e-RS and meet the following criteria:

  • Ongoing management of a patient (patients not currently under review or referred to either UHBristol, WGH or NBT Rheumatology team. For requests for patients currently under review or referred, please write to the responsible consultant).

  • Advice on a treatment plan.

  • Advice on the appropriateness of a referral for their patient (e.g. whether to refer, or what the most appropriate alternative care pathway might be).

  • The most clinically appropriate service to refer a patient into.

The UHB Osteoporosis team will answer questions and queries relating to fragility fracture risk:

  • In which patients DXA (Dual-energy X-ray Absorptiometry) would be indicated and when to request a follow up scan.

  • How to assess future fracture risk, treatment thresholds and arrangements for switching treatment.

  • The absolute risk of adverse events linked to treatment (eg atypical hip fracture, osteonecrosis of the jaw) and advice around breaks from treatment (so-called drug holidays).

  • NICE guidance translated.

  • Special groups (e.g. patients on treatment for breast or prostate cancer, osteogenesis etc.)

The Referral Service may also advise referring GPs to use this service, when appropriate, during the triage of osteoporosis referrals to out patient clinics.