Raloxifene - A review of its use in postmenopausal osteoporosis

Raloxifene is a selective estrogen receptor modulator that partially mimics the effects of estrogens in bone and the cardiovascular system, while func tioning as an antiestrogen in endometrial and breast tissue. In randomised placebo-controlled studies involving postmenopausal women or patients with osteoporosis, raloxifene 60 to 150 mg/day was effective in in creasing bone mineral density (BMD) over 12- to 36-month periods, At the 60 mg/day recommended dosage, increases of 1.6 to 3.4%, 0.9 to 2.3% and 1.0 t o 1.6% were reported in lumbar spine, femoral neck and total hip, respectiv ely, versus less than or equal to 0.5% with placebo. Raloxifene 60 or 120 mg/day decreased the risk of vertebral fractures over a 36-month period in postmenopausal patients with osteoporosis. Significant reductions in radiographic fracture risk versus placebo (30 and 50%) occur red regardless of whether patients had existing fractures at baseline. Alth ough raloxifene did not affect the overall incidence of nonvertebral fractu res, a reduction in the incidence of ankle fracture was reported in compari son with placebo. In postmenopausal women, raloxifene 60 mg/day significantly reduced serum l evels of total and low density lipoprotein cholesterol from baseline, compa red with placebo. High density lipoprotein cholesterol and triglyceride lev els were unaffected. Raloxifene 60 or 120 mg/day reduced the risk of invasive breast cancer by 7 6% during a median of 40 months' follow-up in postmenopausal patients with osteoporosis and no history of breast cancer. A relative risk reduction of 90% was reported for estrogen-receptor positive invasive breast cancers: es trogen-receptor negative cancer risk was unaffected by raloxifene. Raloxifene was generally well tolerated in clinical trials at dosages up to 150 mg/day. Adverse events thought to be related to raloxifene treatment w ere hot flushes and leg cramps. Venous thromboembolism was the only serious adverse event thought to be related to raloxifene treatment and a relative risk of 3.1 compared with placebo treatment was reported in patients with osteoporosis. Vaginal bleeding occurred in less than or equal to 6.4% of ra loxifene-treated women but was reported by 50 to 88% of those receiving est rogens or hormone replacement therapy (HRT). Raloxifene treatment was not a ssociated with stimulatory effects on the endometrium. Conclusions: Raloxifene significantly increases BMD in postmenopausal women and reduces vertebral fracture risk in patients with osteoporosis. In clin ical trials, raloxifene was generally well tolerated compared with placebo and HRT, although its propensity to cause hot flushes precludes use in wome n with vasomotor symptoms. In particular, the lack of stimulatory effects o n the endometrium and the reduction in invasive breast cancer incidence ind icate raloxifene as an attractive alternative to HRT for the management of postmenopausal osteoporosis.