You have been referred to the osteoporosis clinic because you have sustained a fracture of the *hip / vertebra / wrist. This indicates that your bones are thin and that you may have osteoporosis. This puts you at risk of having another fracture. Further investigations are required and treatment may be indicated to reduce the risk of another fracture. Please make a routine appointment to be seen in the osteoporosis clinic by calling the above number. We have enclosed a form to have blood tests done. Please come to the Phlebotomy Dept (level 2, orange wing) with the form to have the tests done at least 2 weeks before your appointment. Phlebotomy is open Mon – Fri 8.30am – 4 pm If you do not make an appointment we assume you do not want further treatment. Yours sincerely Osteoporosis Specialist Nurse EXAMPLE 1b – PATIENT INVITE LETTER
«openingPara» An appointment has been made for you on at «closingPara» «comment»
Yours sincerely Osteoporosis Specialist Nurse
EXAMPLE 2a – GP PATIENT LETTER
Dr EJ SMITH THE SURGERY ANOTHER ROAD CHANDLERS FORD EASTLEIGH HAMPSHIRE 000 000 Dear Dr SMITH, Re: Mrs Belinda TEST Dob: 27/11/1955 Hospital Ref: 123
Your patient has attended … Hospital following a fracture of the hip. This indicates that the patient probably has osteoporosis and is at risk of further fracture. As the patient is over 75 no DXA scan is required. We would suggest screening for secondary causes of osteoporosis by carrying out FBC, and serum creatinine, liver function tests, calcium, vitamin D, CRP and immunoglobulin electrophoresis (to exclude paraprotein.) NICE guidelines for the secondary prevention of osteoporotic fragility fracture were published in 2005. These recommend treatment with bisphosphonates for patients over 75 who have sustained a fragility fracture. We would recommend starting risedronate 35mg weekly (or alendronate 70mg weekly) providing there are no contraindications to bisphosphonates (eg dysphagia, history of oesophageal ulcer, severe renal impairment, patient unable to comply with bisphosphonate instructions) plus calcium and vitamin D supplements (eg Calcichew D3 forte 1 bd.) If bisphosphonates are contra-indicated or poorly tolerated we would suggest prescribing strontium ranelate 2g nocte, again with calcium supplements. We have written to the patient suggesting that they make an appointment to discuss this with you If there are any problems with this, or you would prefer the patient to be seen in the osteoporosis clinic please do not hesitate to contact us. Yours sincerely, Consultant Rheumatologist CC: Mrs Belinda TEST
EXAMPLE 2B – GP PATIENT INVITE LETTER
«ClinicAddress1» «ClinicAddress2» «ClinicAddress3» «ClinicAddress4» «ClinicPostcode»
Ref: NHS Ref: «PatientNHSRef» «GPTitle» «GPInitial» «GPSurname» «GPAddress1» «GPAddress2» «GPAddress3» «GPAddress4» «GPPostcode» Dear «GPTitle» «GPSurname», Re: «PatientTitle» «PatientFirstname» «PatientSurname» «PatientDoB» «PatientGender» Hospital Ref: «PatientHospitalRef»
Your patient has been invited to attend the Osteoporosis Service for an assessment on …………………………………… I will be writing to inform you of his progress. Yours sincerely Day Services Manger
EXAMPLE 2C – GP LETTER PT REFUSAL
«ClinicAddress1» «ClinicAddress2» «ClinicAddress3» «ClinicAddress4» «ClinicPostcode»
Ref: NHS Ref: «PatientNHSRef» «GPTitle» «GPInitial» «GPSurname» «GPAddress1» «GPAddress2» «GPAddress3» «GPAddress4» «GPPostcode» Dear «GPTitle» «GPSurname», Re: «PatientTitle» «PatientFirstname» «PatientSurname» «PatientDoB» «PatientGender» Hospital Ref: «PatientHospitalRef»
Your patient has been invited to attend the Osteoporosis Service for an assessment, but has refused this invitation. We will not be offering a further appointment unless you specifically request this. Yours sincerely Day Services Manger
EXAMPLE 2D – GP PATIENT DNA LETTER
«ClinicAddress1» «ClinicAddress2» «ClinicAddress3» «ClinicAddress4» «ClinicPostcode»
Ref: NHS Ref: «PatientNHSRef» «GPTitle» «GPInitial» «GPSurname» «GPAddress1» «GPAddress2» «GPAddress3» «GPAddress4» «GPPostcode» Dear «GPTitle» «GPSurname», Re: «PatientTitle» «PatientFirstname» «PatientSurname» «PatientDoB» «PatientGender» Hospital Ref: «PatientHospitalRef»
Your patient who was referred to the Osteoporosis Clinic did not attend the appointment on
………………………………………….
A new appointment will not be made but I will accept another referral if it is considered
EXAMPLE 3 GP/HEALTH PROFESSIONAL INAPPROPRIATE REFERRAL LETTER
«ClinicAddress1» «ClinicAddress2» «ClinicAddress3» «ClinicAddress4» «ClinicPostcode»
Ref: NHS Ref: «PatientNHSRef» «GPor health professional Title» «GPInitial» «GPSurname» « GPor health professional Address1» « GPor health professional Address2» « GPor health professional Address3» « GPor health professional Address4» « GPor health professional Postcode» Dear « GPor health professional Title» «Surname», Re: «PatientTitle» «PatientFirstname» «PatientSurname» «PatientDoB» «PatientGender» Hospital Ref: «PatientHospitalRef»
Thank you for referring your patient to the Osteoporosis Service. On reviewing their details
we have decided that this referral is inappropriate for the service that we provide.
It is felt that the patient would be better seen by ………………………………………………
EXAMPLE 4 DEXA REQUEST ANY Hospitals PARK HOSPITAL MEDICAL PHYSICS DEPARTMENT Fax: 000 000 000 BONE DENSITOMETRY REQUEST (DEXA) Tel: 000 000 000
«PatientPostcode» Tel: «PatientPhone»
Clinical Information Additional Clinical Information Peripheral Scan T-Score: EXAMPLE 5 GP DISCHARGE LETTER
«ClinicAddress1» «ClinicAddress2» «ClinicAddress3» «ClinicAddress4» «ClinicPostcode»
Ref: NHS Ref: «PatientNHSRef» «GPTitle» «GPInitial» «GPSurname» «GPCode» «GPAddress1» «GPAddress2» «GPAddress3» «GPAddress4» «GPPostcode» «GPPhone» Dear «GPTitle» «GPInitial» «GPSurname», Re: «PatientTitle» «PatientFirstname» «PatientSurname» «PatientDoB» «PatientGender» Hospital Ref: «PatientHospitalRef»
Your patient who has currently been attending the Osteoporosis Clinic and will be discharged
on …………………………………………………………
A follow up has/has not been arranged. Kind regards. Yours sincerely Day Services Manager EXAMPLE 6 GP RESULTS LETTER showing suggested content for use in an Osteoporosis clinic. Please add to/delete/edit the suggestions to your own requirements, you may have as many choices in each section as you wish. The sentences will appear in drop down boxes from which you choose those relevant to each patient. Ref: NHS Ref: 123 Dr EJ BOVETT G0232126 THE BROWNHILL SURGERY 2 BROWNHILL ROAD CHANDLERS FORD EASTLEIGH HAMPSHIRE SO53 2ZB Dear Dr EJ BOVETT, Re: Mrs Belinda TEST DOB 27/11/1955 113 Winchester Road, Chandlers Ford, Eastleigh, -, SO51 1GY Hospital Ref: 123
Opening para Example 1: Thank you for referring this patient to the osteoporosis service, the results of their assessment and our recommendation are outlined below. Opening para Example 2: This patient has been assessed in the osteoporosis clinic the, results of their assessment together with my recommendations for their management are outlined below. Opening para Example 3: Thank you for referring this patient to the osteoporosis clinic Please contact me if you have any further concerns about this patient. BMD Scores
Interpretation:
This patient's BMD at the spine is normal This patient's BMD at the spine is Osteopaenic This patient's BMD at the spine is Osteoporotic This patient's BMD at the spine is severely Osteoporotic This patient's BMD at the hip is normal This patient's BMD at the hip is Osteopaenic This patient's BMD at the hip is Osteoporotic This patient's BMD at the hip is severely Osteoporotic The result indicated that this patient is at increased fracture risk The result indicated that this patient is at increased falls risk. Vertebral morphormetry suggest a fracture of the vertebra. Vertebral morphormetry suggest multiple fractures of the vertebra. Risk Factors /Issues Identified: Post surgical menopause Early Menopause Steroid Usage Height Loss Low Trauma Fracture Low Body Mass Index Frequent faller Recurrent back pain Maternal history of hip fracture Celiac disease Rheumatoid arthritis Recommendation:
Please consider a bisphosphonate for treating this patient Please consider a bisphosphonate with calcium and vitamin D for treating this patient Please consider alendronate 70mgs weekly for treating this patient I have commenced this patient on alendronate 70mgs weekly I have commenced this patient on calcium and vitamin D tablets daily This patient has been referred to the falls services This patient has been referred to the physiotherapist I have referred this patient for a BMD measurement I have referred this patient to the home hazard team. I have referred this patient to The Stop Smoking Clinic
Closing para Example 1: Please contact me if you need any further help managing this patient. Closing para Example 2: If you have any problems with the management of this patient, please don't hesitate to contact me. Comments example: This where you can add free text
Yours sincerely Consultant Rheumatologist CC: Mrs Belinda TEST
PSA UsedIf pre-biopsy not present, use presenting PSA38% had presenting PSA on GP letterPre-biopsy always Hosp 1Presenting PSA mixture of Hosp 1 and GPDo we need Hosp no for pre-biopsy PSA?Should presenting PSA be Hosp OR GP?Is this data useful?Recommendation: PSA value to be on study db as numeric value to ease analysis. Co-morbiditiesList attached. Can these be further categorised?Diagnosis an
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EXAMPLE 4 DEXA REQUEST ANY Hospitals 
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