Common Questions
Drug Mini-Monograph: Selective estrogen receptor modulators (SERMs) in the prevention and treatment of osteoporosis
See disclaimer below*
Raloxifene, a selective estrogen receptor modulator (SERM), is FDA-approved for the prevention and treatment of osteoporosis in postmenopausal women. It decreases bone resorption and overall bone turnover. This effect is mediated through selective estrogen receptor binding, resulting in activation of certain estrogenic pathways and blockade of others. Raloxifene may have fewer estrogenic effects on uterine and breast tissue. Tamoxifen, a SERM used in the prevention and treatment of breast cancer, weakly increases bone mineral density to a much lesser degree and is not used for treatment or prevention of osteoporosis.
Dosing. See the table below.
Cautions and contraindications. Avoid in patients with a history of thromboembolic disease or in women who are or may become pregnant.
Side effects. The most common side effects are hot flashes and leg cramps. There is an increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), especially 4 months after initiation of therapy. If a patient requires prolonged immobilization, discontinue raloxifene at least 72 hours prior to and during immobilization.
Drug interactions. Both ampicillin and colestyramine decrease raloxifene levels by inhibiting enterohepatic cycling. Raloxifene has been shown in single dose studies to decrease the effect of warfarin.
| Product | Available Strength | Osteoporosis Dose | Side Effects | Comments |
|---|---|---|---|---|
| Raloxifene (Evista®) | PO: 60 mg tablet |
Treatment/ Prevention:60 mg p.o. qd |
Hot flashes, leg cramps | Increased risk of DVT and PE, especially within first 4 months of therapy; discontinue 72 hours prior to and during prolonged immobilization |
*Disclaimer: This brief overview is limited in scope and designed to serve as a learning resource and an initial reference source. The information presented here should not be used in making treatment decisions. The authors, editors, developers, testers, and the University of Washington School of Medicine are not responsible for any errors in diagnosis or treatment that may result from the use of this material.
For more information on the use of SERMs in the prevention and treatment of osteoporosis, work through the SERM case or search the OsteoEd web site under "SERMs."