[Role of estrogen and selective estrogen receptor modulators in anti-aging]

Changes in bone mass and estrogen levels occur in almost total sync with one another in a woman's lifecycle, with bone mass shown to increase in response to increases in estrogen in early adolescence and to decrease in response to decreases in estrogen during perimenopause. Therefore, menopause as it leads to estrogen deficiency is among the greatest causes of osteoporosis, and estrogen replacement therapy represents a highly rational therapeutic approach. However, it is of note that estrogen is associated with increased risk for breast cancer, while selective estrogen receptor modulators (SERM) are associated with no such risk and thus represent prophylactic and therapeutic agents for breast cancer. Of all SERMs, raloxifene is currently the only agent covered by insurance and available for the prophylaxis and treatment of osteoporosis. The current review therefore focuses on the role of estrogen and raloxifene in the management of osteoporosis.