The integrity of bone tissue and its remodeling that occurs throughout life requires a coordinated activity of osteoblasts and osteoclasts. The decreased
estrogen circulating level during postmenopausal transition, with a prevalence of osteoclastic activity over osteoblastic activity, represents the main cause of bone loss and
osteoporosis.
Osteoporosis is a
chronic disease requiring long-term
therapy and it is important to evaluate the efficacy and safety of treatments over several years, as the fear of health risks is a common reason for discontinuing
therapy.
Raloxifene is a
selective estrogen receptor modulator (
SERM) leading to
estrogen-agonist effects in some tissues and
estrogen-antagonist effects in others.
Raloxifene is effective to prevent and treat postmenopausal vertebral
osteoporosis, with reduction of spine fractures and, in post-hoc analyses, non-spine fractures in high-risk subjects. Moreover,
raloxifene reduces the risk of invasive
breast cancer and improves the levels of serum
lipoprotein but with an increased risk of
venous thromboembolism and fatal
stroke, without significant change in the incidence of coronary events. For these reasons the overall risk-benefit profile is favorable. Therefore, when considering the use of
raloxifene in a postmenopausal woman, we should take into account the
osteoporosis-related individual risk and weigh the potential benefits, skeletal and extra-skeletal, against the health risks.