OsteoEd

SERMs in Osteoporosis

A 66-year-old woman is concerned about osteoporosis. She recently had a DEXA study that showed a T score of the lumbar spin to be -2.6 and a T score of her hip to be -2.0.

She has generally been healthy. Her only active medical problems include hypothyroidism and severe gastroesophageal reflux that is intermittently controlled with a proton pump inhibitor. She has no history of cancer, DVT, or fractures. There is no family history of heart disease or diabetes but her mother had breast cancer. Her total cholesterol is 230 mg/dL with an LDL of 160 mg/dL. Her medications include pantoprazole and levothyroxine.

Click an answer under each question.

1. You decide to treat her with raloxifene as she is not a candidate for alendronate due to her GERD and she is not interested in using a nasal spray. Which of the following statements is true about raloxifene?

   • Option A Decreases hip fractures by 30%
   • Option B Does not reduce fracture risk, but increases BMD by 30-40%
   • Option C Decreases vertebral fractures by 30-50%
   • Option D Decreases both hip and vertebral fractures by 20-30%

2. She has a family history of breast cancer. How does raloxifene affect the risk of invasive breast cancer?

   • Option A No effect
   • Option B Same effect as tamoxifen
   • Option C Unclear, studies are inconclusive
   • Option D Same effect as estrogen

3. Which of the following might she experience if she begins raloxifene?

   • Option A Hot flashes, relief from vaginal dryness, and decreased breast tenderness
   • Option B No effect on hot flashes, relief from vaginal dryness, and increased breast tenderness
   • Option C Hot flashes, no effect on vaginal tissues, and increased risk of uterine cancer
   • Option D Hot flashes, no effect on vaginal tissues, and increased risk of venous thrombosis

4. She wants to know if raloxifene will interact with levothyroxine. Which of the following is true?

   • Option A There are no reported drug interactions between raloxifene and levothyroxine.
   • Option B Raloxifene may interfere with absorption of levothyroxine resulting in an increase in TSH.
   • Option C Levothyroxine interferes with the absorption of raloxifene and a higher dose of raloxifene (120 mg /day) is required.

5. Your patient returns after several months. She initially experienced mild hot flashes but these have decreased, and she is tolerating raloxifene well. She wants to know if it will effect her cholesterol level or cause heart disease. Which statement about raloxifene's effects on lipids and coronary heart disease (CHD) is most accurate?

   • Option A Increases both LDL and risk of CHD
   • Option B Decreases LDL, HDL, and CHD
   • Option C Decreases LDL with no effect on CHD
   • Option D Decreases triglycerides and increases HDL with no effect on CHD

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