[Raloxifene and bone quality issues]

With advances in clinical research in osteoporosis management, there has occurred a shift in therapeutic endpoints in osteoporosis from enhancement of BMD (bone mineral density) to prevention of bone fractures. Of note in this connection is the observation that fluoride therapy was associated with significant increases in BMD but was not preventive of bone fractures;on the other hand, raloxifene, while not as effective as bisphosphonate in increasing BMD, was preventive of bone fractures to a degree comparable to bisphosphonate therapy. This finding suggested that there should be more factors implicated in preventing bone fractures than increasing BMD, pointing to the importance of bone quality, as had been speculated in earlier studies. Thus, raloxifene has contributed in no small way towards advancing osteoporosis management. But in the same breath, the issue of bone quality still remains to be further explored, and further advances in both basic and clinical research are required to elucidate what it is that constitutes bone quality, as well as to establish a methodology for the assessment of bone quality.