Raloxifene to prevent postmenopausal osteoporosis

Raloxifene (Evista-Lilly) belongs to a family of drugs described as 'selective oestrogen receptor modulators' (abbreviated to 'SERMs' to reflect the American spelling of oestrogen) of which tamoxifen should probably be regarded as the first example. Raloxifene is licensed in the UK for the prevention of non-traumatic vertebral fractures in postmenopausal women considered at increased risk of osteoporosis. The drug is promoted as "a new way of protecting women after the menopause without using hormones". The manufacturer claims that raloxifene "increases bone mass and reduces the risk of vertebral fracture" and "improves the lipid profile", while causing "placebo levels of breast symptoms ... and uterine bleeding". A further claim is that raloxifene "has reduced the incidence of newly diagnosed breast cancer in clinical trials". We examine these claims.