Use of selective estrogen receptor modulators in osteoporosis
SERMS are agents that function as estrogen agonists in some tissues (bone) and estrogen antagonists in other tissues (breast). Raloxifene (Evista) is a SERM that has been shown to improve bone mass and to reduce spine (not hip) fractures; it is FDA-approved for the treatment of postmenopausal osteoporosis. Raloxifene has also been shown to reduce the risk (76%) of developing invasive breast cancer. The dose is 60 mg daily. Side effects include hot flashes, leg cramps, and an increased risk of thromboembolic disease (especially in smokers) similar to that seen with HRT. Raloxifene increases BMD by 2% to 3% in both the spine and hip while reducing the relative risk of vertebral fractures by 31% to 49% without an effect on hip fracture reduction. An ideal patient to receive raloxifene is an osteoporotic postmenopausal patient with a personal or family history of breast cancer. It can also be used in osteoporotic patients with CKD, although little data is available to support its efficacy in this patient group.