Provided by ISL Consulting Co.

Selective estrogen receptor modulators, or SERMs, are a relatively new group of drugs. One SERM, raloxifene, provides promising benefits for women with osteoporosis, and other SERMs may soon join the ranks of osteoporosis medications. The concept of SERMs may be new to you, but you've probably heard of tamoxifen, a SERM used to treat breast cancer.

What are SERMs?

It may be a mouthful, but selective estrogen receptor modulators do just what their name describes. They select specific estrogen receptors in the body and either stimulate or depress an estrogen-like response. In other words, SERMs cause estrogen-like responses in certain tissues while preventing estrogen-like responses in other parts of the body.

Raloxifene (Evistaź) is a SERM that works like estrogen to reduce bone loss and increase bone density. It comes in tablet form and can be used to prevent and treat osteoporosis in postmenopausal women.

At this time, raloxifene is the only SERM available to treat osteoporosis, but other SERMs are being studied for their bone strengthening potential.

What are the Benefits?

There are no cures for osteoporosis, but raloxifene can help reduce the effects of the condition. Raloxifene can:

• Prevent bone loss throughout the body
• Increase bone density
• Reduce the risk of hip and spinal fractures

Like estrogens, raloxifene may also provide some protection against heart disease. Unlike estrogen, raloxifene does not appear to increase the risk of uterine cancer or breast cancer. On the other hand, it will not simultaneously treat menopausal symptoms as estrogen does.

What are the Risks?

Like estrogen, raloxifene carries a risk of blood clots. If you're considering taking raloxifene, talk to your doctor about your risk of blood clots.

Because this medication is relatively new, there may be additional risks that doctors are not yet aware of.

Before taking this medication, be sure to tell your doctor about any other medical conditions you might have. It's also very important to tell your doctor about any medications that you're taking, even if they're over-the-counter. Adverse drug interactions can occur, even with non-prescription medications. In some cases, a drug combination may not be dangerous, but your doctor may change your dosage or take other precautions.

It's also a good idea to tell your doctor about any allergies you may have, especially if you're allergic to certain foods, preservatives, or dyes.

What are the Possible Side Effects?

As with any medication, raloxifene has a number of possible side effects.

Rare side effects that require emergency attention:

• Coughing blood
• Severe headache or migraine
• Loss or change in speech, coordination, or vision
• Pain or numbness in arm, chest, or leg
• Unexplained shortness of breath

If your doctor prescribes raloxifene, you will receive a product information sheet along with your medication. Be sure to consult this sheet, as it will provide you with a detailed list of possible side effects. If you experience any other side effects, consult your doctor.

Calcium

Calcium is an essential part of any osteoporosis treatment or prevention regimen. If you are taking medication to prevent or treat osteoporosis, you still have room for improvement if you're not taking calcium.

If you have osteoporosis, or are at risk for the condition, your daily calcium intake should be 1,200 to 1,500 mg per day. Green leafy vegetables are an excellent source of calcium, but it's also a good idea to take a calcium supplement, especially if you are at risk for fractures.

For optimum benefit, add vitamin D (800 IU) to your calcium supplementation. Ask your doctor or health care provider to recommend a good multivitamin and a good calcium supplement.

A Word to the Wise

There is no cure for osteoporosis (at least not yet!), so it's important to continue taking your medication even if you feel fine. If you feel the need to discontinue the treatment, talk to your doctor first. And don't forget the valuable benefits of exercise and good nutrition; they can go a long way in supporting the treatment you're taking.

Last Reviewed: June 4, 2002