Treatment of osteoporosis and reduction in risk of invasive breast cancer in postmenopausal women with raloxifene

Abstract

Introduction Raloxifene, a non-steroidal selective estrogen receptor modulator (SERM), offers a new dimension for the treatment and prevention of osteoporosis and risk reduction of invasive breast cancer in postmenopausal populations at high risk. Both osteoporosis and breast cancer are important public health issues for postmenopausal women. It is well known that estrogen and estrogen receptors play an important role in the pathogenesis of both diseases. Initially, hormone replacement therapy (HRT) was used for the purpose of preventing and treating postmenopausal osteoporosis. However, HRT significantly contributed to an increase in breast cancer risk. The SERM, raloxifene, is used for the prevention and for the treatment of post-menopausal osteoporosis and reducing the risk of invasive breast cancer in postmenopausal women. Areas covered This article reviews the emerging evidence of the efficacy of raloxifene in postmenopausal women, summarizes the results and places in perspective their therapeutic uses for women having either a high risk of osteoporosis or breast cancer. Emerging clinical evidence suggests bisphosphonates, currently used as drugs for the treatment of osteoporosis, may also reduce breast cancer risk. The status of other SERMs and bisphosphonates are included for completeness. A Medline search of raloxifene, osteoporosis, breast cancer and SERMs was used to derive a database of 355 references. Expert opinion Readers will understand the value of raloxifene to prevent osteoporosis and breast cancer in postmenopausal women. Although most women do not require pharmacotherapy for menopausal symptoms, many are severely affected by osteoporosis or breast cancer at and beyond menopause and, for such women, pharmacologic intervention is important if they are to retain an acceptable quality of life. It is reasonable to use raloxifene or bisphosphonate as an appropriate drug that targets symptom-free postmenopausal women for treatment and prevention of osteoporosis but raloxifene is proven to reduce the incidence of invasive breast cancer.

Independent Association between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: A Systematic Review and Meta-Analysis

“…Firstly, similar to other reports [9, 16, 33, 40], the diagnosis of NAFLD obtained in our study was based on ultrasonography or computed tomography (CT) and the exclusion of known causes of chronic liver disease but was not confirmed by liver biopsy. Although liver biopsy remains the gold standard for NAFLD diagnosis and evaluation, it is difficult to conduct in large populations, and ultrasonography remains the most common way of diagnosing NAFLD in clinical practice due to its good sensitivity and specificity in detecting moderate and severe steatosis [41].…”

The Dual Estrogen ReceptorαInhibitory Effects of the Tissue-Selective Estrogen Complex for Endometrial and Breast Safety

“…To overcome the undesirable side effects of tamoxifen, raloxifene (second-generation SERM) was developed (Black et al, 1994). Because raloxifene reduced the incidence of invasive breast cancer in postmenopausal women with osteoporosis, raloxifene is the current preferred drug for women at risk for vertebral fracture who have an elevated risk of breast cancer (Ko and Jordan, 2011;Gizzo et al, 2013). Unlike tamoxifen, raloxifene does not increase the risk of uterine cancers (Vogel et al, 2006;DeMichele et al, 2008;Pinkerton and Goldstein, 2010), even when combined with vaginal estrogen (Parsons et al, 2003;Pinkerton et al, 2003).…”

Antileishmanial Activity of the Estrogen Receptor Modulator Raloxifene

“…Drugs belonging to a second class of SERMs built on a benzothiophene scaffold are also in clinical use. One example of this second class is raloxifene, an oral SERM which has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue [10] , which results in skeletal benefit, with little, if any, uterine stimulation [11] .…”