Selective estrogen receptor modulators

Raloxifene is a selective estrogen receptor modulator that reduces postmenopausal bone loss. Raloxifene reduces vertebral fracture risk in women who are more than 3 years postmenopause, but does not appear to reduce nonvertebral (including hip) fracture risk. It reduces the risk of breast cancer, but increases the risk of venous thromboembolism, and causes a small increase in the risk of death after stroke. It also increases hot flushes.

Raloxifene is most appropriate for treating younger postmenopausal women (younger than 60 years) with spinal osteoporosis, and may be a particularly suitable choice in women at high risk of breast cancer. Use:

A combination formulation (known as a tissue-selective estrogen complex) containing conjugated estrogens and the selective estrogen receptor modulator bazedoxifene is also available for management of menopausal symptoms. This formulation improves hip and vertebral BMD. The effect on fracture risk has not been studied; however, studies of bazedoxifene alone showed a reduction in vertebral fracture risk similar to raloxifene. It is typically used for women younger than 60 years who have menopausal symptoms. At the time of writing, this formulation is not available on the Pharmaceutical Benefits Scheme (PBS); see the PBS website for current information.