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Related Experiment Videos

Selective estrogen-receptor modulators.

Felicia Cosman1

  • 1Helen Hayes Hospital, Route 9W, West Haverstraw, NY 10993, USA. cosmanf@helenhayeshosp.org

Clinics in Geriatric Medicine
|August 15, 2003
PubMed
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Selective estrogen receptor modulators (SERMs) like tamoxifen and raloxifene offer benefits for breast cancer patients and postmenopausal women. However, their impact on bone health and fracture risk varies, necessitating careful consideration of individual patient profiles and potential risks.

Area of Science:

  • Endocrinology
  • Oncology
  • Geriatrics
  • Pharmacology

Background:

  • Tamoxifen is used for breast cancer treatment and prevention, with differing risk-benefit profiles for premenopausal and postmenopausal women.
  • Postmenopausal women on tamoxifen may see increased bone mineral density (BMD), but its effect on fracture risk remains unclear.
  • Raloxifene demonstrates efficacy in reducing vertebral fractures and breast cancer risk in postmenopausal women, with minimal impact on bone mass.

Purpose of the Study:

  • To evaluate the efficacy and safety of tamoxifen and raloxifene in managing bone health and reducing fracture risk in postmenopausal women.
  • To compare the risk-benefit profiles of tamoxifen and raloxifene concerning skeletal health, breast cancer prevention, and adverse events.

Main Methods:

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  • Review of clinical data on tamoxifen (20 mg/d) and raloxifene (60 mg/d) in postmenopausal women.
  • Analysis of effects on bone mineral density (BMD), vertebral and nonvertebral fractures, and cancer incidence.
  • Assessment of adverse events, including thromboembolism and uterine disease.

Main Results:

  • Tamoxifen may increase BMD in postmenopausal women, but fracture risk reduction is uncertain; addition of bisphosphonates may be considered for osteoporosis.
  • Raloxifene reduces vertebral fractures and ER-positive breast cancer risk, increases bone mass slightly, and reduces bone turnover without increasing uterine disease.
  • Both SERMs increase venous thromboembolism risk, contraindicating their use in women with a history or high risk of such events.

Conclusions:

  • Raloxifene is most beneficial for women aged 55-65 with osteoporosis or at risk, particularly those experiencing menopausal symptoms or seeking breast cancer risk reduction.
  • Tamoxifen may be adequate for women with moderate risk and bone density above osteoporosis range for up to 5 years.
  • Neither SERM is ideal for elderly women at high risk of hip fracture; alternative treatments should be considered.