title: Assessment of bone health in breast cancer patients starting adjuvant aromatase inhibitors: A quality improvement clinical audit.
abstract: BACKGROUND
  Adjuvant Aromatase Inhibitors (AIs) predispose breast cancer patients to accelerated bone loss. Guidelines recommend initial screening and follow up of bone mineral density with dual energy X-ray absorptiometry (DEXA) scan. In this audit we assessed the rate of adherence to these guidelines and introduced awareness measures to improve it.
  
  
  METHODS
  All post-menopausal women who started upfront adjuvant AIs (letrozole in all patients) between January 2007 and December 2013 were retrospectively identified. The standard to be audited was "These patients should have a baseline DEXA scan requested within the first 3 months of starting adjuvant AIs therapy". A 90% or more compliance was accepted as satisfactory. Corrective measures in the form of educational and awareness sessions followed by re-auditing of the practice over the subsequent 12 months were planned in case of lower compliance rate.
  
  
  RESULTS
  Three hundred and sixty seven eligible patients were identified. Baseline DEXA scan was performed in 188 (51.2%) patients. As planned, this result triggered the conduction of 4 consecutive educational sessions over a period of 2 weeks. Re-auditing the practice in the pre-defined subsequent subjects showed compliance in 47/52 (90.4%) patients.
  
  
  CONCLUSIONS
  This study of a sizable cohort confirms previous observations that adherence to skeletal health guidelines in this patient population is less than adequate. Adherence is improved dramatically by raising the awareness of relevant physicians.
authors.affiliation: Associate Professor, Al-Faisal University, Saudi Arabia; Consultant Oncologist, King Faisal Special Hospital & Research Centre (Jeddah), PO BOX 40047, Jeddah 21499, Saudi Arabia.
authors.forename: Jamal
authors.initials: J
authors.lastname: Zekri
authors.affiliation: Lecturer of Medical Oncology, Mansoura University, Egypt; Assistant consultant Oncologist, King Faisal Special Hospital & Research Centre (Jeddah), Saudi Arabia.
authors.forename: Kamel
authors.initials: K
authors.lastname: Farag
keywords: Aromatase inhibitors; Bone health; Breast cancer; Clinical audit; DEXA scan